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► I I 1 I 1 1 I i 1 1 <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS A REPORT 1 ' 1 <br /> Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: 0 Sampler(s): a.ncz4 <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: - Time: 4—"P P Mileage: <br /> If yes,To: State Client Other <br /> Lab r: ` — C <br /> Phone: P I x <br /> Y ti v <br /> FAX: �I — 2 2 " _ <br /> ° swG z <br /> a ; o v Go v <br /> Project name: �J� -T Ik 1. L�-`L ' F Q cc Q <br /> a�3 <br /> 5 -FA q z W o <br /> Contact person: 1e_ aF z I b z o `� <br /> SAMPLE INFORMATION 9) op <br /> o - a w <br /> Sample Date Time a a¢ a 3 3 m x z <br /> Number Location Description Sample Sample F z'° w �?3 't a U <br /> v�J s T es •orJ <br /> v <br /> CUSTODY <br /> 77-77 <br /> Relinquished by: ate k Time 4_'-4-5 Received by: 0 o n N ae Date►2.1 iNJ#%Time <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 />