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ri t --,-i R�.�w,,: S Y..F {1 E �L.� .1 l ivF <br /> CHAIN OF CUSTODY <br /> .•PREEl51DN ENVIRO EH AND ANALYSIS REQUEST DOCUMENT m <br /> REPORT INFORIVIATION <br /> Rush Analysis: 6 Days _2 Days,_24hrs` m <br /> m <br /> Client: Nr 6 C in. 4NDE9 �61' + �15�4� Sampler(s): --1 <br /> Subject to surcharge <br /> H <br /> Customer Number: QAIQC report reqs <br /> Comp Sampler Set Up Date:— Time:- ed: yes ua <br /> co <br /> If yes, To:State Client Other <br /> Address: � <br /> _ . 8 F� u��roa t_� _ _ Time: Mileage: <br /> N <br /> Go 10 C A 40 Lab number: a <br /> m <br /> N <br /> �f <br /> Phone: - OJ r w <br /> 3 0 o M Cron <br /> FAX-' " r 45 x <br />( Project name: e � J �. <br /> Contact person: AV rn <br /> z 33 U <br /> y y y <br /> sample Date Time a a° S x 4 y U n <br /> Number Location Description Simple Sample Z5 a mv3 �' ` +-i <br /> to <br /> S 1z 23 a <br /> z <br /> 4 <br /> 7U <br /> y <br /> (/` 0 <br /> ? V <br /> 1:49— <br /> Relinquished b{. T"` to�Time 194 Received by����' Date�'�3y�'I'ime <br /> Relinquished by: Date ' Time Deceived by: Date Time <br /> G) <br /> Relinquished by: Date Time I(eceived by: Date Time <br /> PRECISION ENV1RO-TECH 545 E. Cleveland, Suite A* Stockton CA 95204 Telephone (209) 462-0892'*FAX:(209)462-?935 <br />