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F�I��r.15101�1 ENViRO-TECH CHAIN OF CUSTODY <br /> AND,"VALYSIS REQUEST DOCUAb1EJVT <br /> CLIENT DETAILS WAVI^ • 1 REPORT INFORNIATION <br /> Client: Sampler(s): I 10-e b AylW,e Rush Analysis: 5 Days _ 2 Days_24brs_ <br /> � <br /> Subject to surcharge <br /> Customer Number: <br /> 1- ----t-2 <br /> Cornp Sampler Set Up Date:_ Time: QA/QC report required: yes_ no _ <br /> Address: U- —2/$4 <br /> Time: Mileage: IF yes, To: State _Client _Other <br /> Lab number:5 O so C;1 1 - 0 f <br /> Phone: X09 — 3 <br /> U <br /> s � 5 <br /> FAX: �o y - 03y - 07_23 <br /> Project name: <br /> to <br /> Contact person: <br /> -. '-F zw y �y z o tq �. �� -• <br /> SAMPLE <br /> • . 14 <br /> m <br /> Sam !e <br /> Number Location Description sDapl sample z'i go - <br /> 'a 33 r. N ro cr. <br /> 5 ® :3P! G� . <br /> Spl ioo' r�oW Bat✓7' <br /> Relinquished by:— Date S Ti�%� �� Receive 6 Dat ima l y <br /> Relinquished by: Date _Time Received by: Date . 'rime <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N. West Lone,Suite S2 v Stockton CA 96210 4 Telephone(209)477-8105 FAX:(209)477-8248 <br />