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i t r r r r r t r r <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> INFORMATIONCLIENT DETAILS RU, PORT <br /> Client: U Sampler(s): <br /> Rush Analysis: 5 Days _2 Days_24hrs_ <br /> � _ <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: <br /> Phone: is I �i v <br /> 6 � x <br /> a s" <br /> FAX: x - A <br /> P <br /> s m o z L4 <br /> Project name: r'i l 6 ° a q <br /> g eA I F z <br /> e , m Gm <br /> Contact person: �C- g d= v ° C �,� <br /> .�F z mss '' z ° W G ro <br /> g * e wa <br /> = e3 3 SAMPLE INFORMATION <br /> ydx L� <br /> Sample Date Time <br /> NumberLocation Description Sample sample <br /> CUSTODY <br /> Relinquished by:41- Date 7 p Time Received by: J- =' Date `L % "Time '`•� <br /> Relinquished by: Date Time Received by: Date - Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane, Suite B2 *Stockton CA 95210*Telephone(209)477-8105 *FAX: (209)477-8148 <br />