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PREEISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS A Mm7 <br /> Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: I i r Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time:_ <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: <br /> Phone: x <br /> s <br /> a m = A a <br /> FAX: gg y ti 3sr <br /> i <br /> Project name: ) U <br /> � o <br /> Contact person: e z s q z" o `� q79 <br /> SAMPLE INFORMATION <br /> SampleDate Time `�a ^O <br /> Number Location Description Sample sample <br /> r <br /> CUSTODY <br /> Relinquished by: Date Time Received by: - Date ,.._Time <br /> Relinquished by: Date _Time Received by: Date.Time <br /> 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 />