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PRECISION ENVIRO-TECH CHAIN OF ',CUSTODY <br /> tf AND AIVALYSIS REQ UEST DOCUMENT <br /> DETAILS • REPORT1 ' • <br /> CLIENT Rush Analysis: 5 Days _2 Days_24hrs_ <br /> Client: �I LJ_0 J M LY2-PO'`J Sampler(s): M I VLF -70 <br /> Subject to surcharge <br /> Customer Number: QAJQC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> n ,k <br /> Address: r d' 'ox �� V Time: If if yes, To: State Crli nt Other <br /> L O D; <f4 I <�+I Lab number: <br /> Phone: -374—_ 6613 <br /> (?,�� ) 33 —0723 y �5 b 0 x <br /> FAX: � �� m a <br /> Project name:— <br /> Contact <br /> ame:Contact person: /Vj l KC T!1 y� .: '/t�t1/L d o <br /> SAMPLEi ' • <br /> Date me d o w mSampleLocation Description Sample $ample S wNumber a x <br /> v <br /> S07 t0 1X1 w <br /> 4 <br /> • CUSTODY <br /> ii � yr <br /> Relinquished b Dat efime'1�eceived by:�//!1\lam_ Dat��Time �0 <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 />