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PRECISION ENVIROmTECH CHAIN OF CUSTODY I� <br /> ANDANALYSIS REQUEST DOCUMENT <br /> Rush Analysis:5 Daya_2 Dsys_24hn <br /> Client: '1 7pler(s): . <br /> Subiectto surcharge <br /> Customer Number; Q.A/QC report required: yea_ no <br /> Sampler Set Up Date:—Time:_ <br /> Address: Time: e If yes,To:State_Client _tither <br /> 1 Lab number: <br /> 3 � n <br /> VAX- <br /> Project <br /> AR:Fro ect name:!' Y`, .. . Yom' pa x<1r 4 e $ sT 3 A z <br /> a o La <br /> ..1 'S v � �Eg ,] rt 7. fI y <br /> Contact person. 71 a y8 B Jw ; ' $ m <br /> $ample- Date Time <br /> xumber Location Description Sample sample �" ' � <br /> s.�S .V-d+} <br /> riE Gar v.er a iru•:lunc� <br /> lo�ird•.o5 <br /> � <br /> yf- t1 05 <br /> Relinquished bye ��—� ���-e� Dated l'+ T.L Z_42h Received by: m �. Date�,�t�l`iS.Time N <br /> 77 <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$2*Stockton CA 95210'Telephone(209)477-8105*FAR:(209)477-8148 <br />