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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORTINFORMA'VION' <br /> M V�P H M I Rush Analysis: 5 Days _2 Days_24hre <br /> Client: D IL-�^' � Sampler(s): <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:_ Time: <br /> Q M QA/QC report required: yes— no <br /> _T <br /> P p. F,-;)A 7i( Q c7 If yea,To: State _Client Other <br /> Address: Time: Mileage: 1 Q� M2 - 01- <br /> k�OL)i CA Q( �?1} Lab number: 5 © 1 <br /> Phone: (tel) <br /> x <br /> 33:+-o'72-3 <br /> FAX: <br /> �a x <br /> Project name: ' $D^j g Z5 aQ <br /> A z� <br /> Contact person: AA L Kc3 '(D a m o ;00 m <br /> ;5SAMPLE INFORMATION <br /> �$ <br /> > m <br /> Semple Location Description tion Data Ti p <br /> Number Sample Sam le l zzos` a o <br /> w o m Ft <br /> P U <br /> 4330 �Q.t16•- R-o, si��e w6w y_/c-�/ �Z��o �W - — X <br /> Relinquished by' Date t—It' Time Received by: DateIfir lITimeS M <br /> Relinquished by: —Date —Time Received by: Date Time <br /> Relinquished by: _ —Date _Time Received by: Date Time <br /> PRECISION ENVIR.O-TECH 3935 N. Coronado Ave. * Stockton CA 95204*Telephone(209)477-8105 *FAX-(209)546-7497 <br />