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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: r _/ Sampler(a): �AT�� a sue L <br /> Subject to surcharge <br /> Customer Number: 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 /> S _ x <br /> FAX: <br /> w J <br /> Tsz ax <br /> a o v ° <br /> Project name: s d 3 a m g m F 4 2 <br /> N _ <br /> g o 5sFe 9 � W o w � <br /> 1 k ^MI <br /> Contact person: F Z s z <br /> SAMPLE INFORMATION <br /> Sample Date Time <br /> Location <br /> Number ocaon Description Sample Sample z'> 2— <br /> Relinquished <br /> ?Relinquished by: Date—Time Received by: Date 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 />