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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> �U Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: ��� ���� Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> 7 Comp Sampler Set Up Date:— Time: <br /> Address: ���` "� J Time: Mileage: If yes, To: State Client Other <br /> 24 Lab number: <br /> Phone:-(1-01) 334— "13 <br /> (2,5) 334 — 0-7 23 e y 3�3 <br /> FAX: <br /> c� <br /> MaJLSc �la�(c- V 0 <br /> Project name: " R F Q s ¢ ° <br /> �: <br /> y � B 3�3 N N o <br /> q o c? Fo o z W :aj <br /> Contact person: <br /> U d F o an <br /> z z 0 <br /> o a <br /> x W \ o ao Q a <br /> • • \Cly m <br /> o L = J �a <br /> Sample Date Time <br /> Number Location Description Sample Sample E z'> ? 3 3 3 f Q U <br /> 16110 SA�'T �6. sP��0 w�U, i��7� 12 35 �'p y° <br /> CUSTODY <br /> Relinquished b Date Time `� Received atee <br /> 77 <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, Suite A Stockton CA 95204*Telephone(209)462-0892 =r FAX: (209)462-7935 <br />