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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS 1 ' 1 <br /> �� Rush Analysis: 5 Days A 2 Days_24hrs_ <br /> Client: �1 �`0'\ � AAL),a�-y Sampler(s): <br /> (� <br /> Subject to surcharge <br /> Customer Number: D �-1 Comp Sampler Set Up Date:ILS Time: li;3 QA/QC report required: yes no <br /> — <br /> Address: P'0- �6 2-(So Time: Mileage: If yes,To: State Client Other <br /> q 51N 1 Lab number: (3 Z S O 2- <br /> Phone: Zo CL� 33H -(etc 13 <br /> s d x <br /> FAX: (Zc�k) o A <br /> a sm o z <br /> Project name: i3`' !" LIQ a r " W v F A A ¢ <br /> Z 4 1 m' <br /> S o zw <br /> Contact person: Vu- 1-0', =F z d z o <br /> s s W [ <br /> SAMPLE INFORMATION <br /> • • E m ? > o f d � <br /> m 'F a O <br /> Sample Date Time Ca <br /> Number Location Description Sample Sample F z° cc 0 3 Q' an d U <br /> t <br /> i ,NI+ <br /> t <br /> 7777 CUSTODY <br /> Relinquished by:-aK11'_1 DateL_aLk-Time I :!x'/'ft Received by: Date 2-5ime 3, <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 />