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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT 1 7-- <br /> Comp <br /> REPORT INFORMATION <br /> 1, �� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: I � ' + <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Sampler Set Up Date:— Time: <br /> Address: Time: Mileage: If yes,To: State —Client Other <br /> Lab number: <br /> t1hone: <br /> s � 5 <br /> a m <br /> FAX: o A <br /> Uj <br /> 00 <br /> Project name El <br /> Contact person: i o <br /> o <br /> G G am, <br /> m <br /> ySAMPLE INFORMATIONy 4 qy x s <br /> Sample Location Description Date Time ;o U 6 a q �`� v <br /> Number Sample Sample z> ,F <br /> 11 <br /> Relinquished by-I t. Date,'. Timeli �'Lo Y', Receivedby: Date I+ ,I. Time <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> 1 pRF^')IOi""lTVI"—ITE(—"1774. -'INes }e, S " 132 * - Jktor - 1952 - 1l'ele - le(2t F748 -r FA-- 109) f 148 1 J <br />