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PRECISION ENVIRD-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Rush Analysis: 5 Days24hrs <br /> 2 Days_ 7� <br /> Sampler s). <br /> Client: <br /> Sampler(s): Subject to surcharge <br /> Customer Number: KJ t. QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> If yes,To: State Client Other <br /> Address: Time: Mileage: <br /> Lab number: <br /> Phone: <br /> FAX: 0 <br /> 0- <br /> 1 � M <br /> E3 <br /> Project name:- <br /> E- < <br /> 3 <br /> 5 -te Q N z <br /> Contact person: & <br /> El z z 4 <br /> C <br /> SAMPLE INFORMATION . 0 4111 <br /> Time 4A <br /> Sample Date 0 'Z Ctl C) <br /> ion 2 <br /> Location Descripti Sample Sample E5 <br /> Number <br /> 5V <br /> c <br /> CUSTODY <br /> 1 ty <br /> Relinquished by:` I➢i) -, TiA Received by: Date Time <br /> Relinquished by: Date —Time—Received by: DateTime7777 <br /> Relinquished by: Date —Time—Received by: DateTime <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2 * Stockton CA 95210 *Telephone(209)477-8105 FAX: (209)477-8148 <br />