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PREUSION ENVIRO=TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> 1 <br /> DETAILS <br /> REPORT1 OR <br /> CLIENT Rush Analysis: 5 Days 2 Days*24hrs <br /> Client: ��Lt � �• �'►'� � �SS•0 C � Sampler(s): � C-��a.��- — <br /> 6ubject w surcharge <br /> Customer Nu <br /> mber: { J Comp Sampler Set Up Date:—Time: QA/QC report.required: yes no <br /> Address: <br /> "�Q 2 I l�Gi/ L4),l X�1 III <br /> Time: Mileage: If yes,To: State Client. Other <br /> Jo at) - , 9 4 b Lab number: <br /> Phone: 3(a� - (��iG� �•, x <br /> FAX: <br /> z v� a <br /> � <br /> Project name: l-+'r��S !'�P2��+'1 = 3�3 a. <br /> i fFe h 7 l <br /> Contact person:_ 02 <br /> C C F Z _ yT z <br /> 72 <br /> Da4 i <br /> SAMPLE INFORMATION <br /> Sample te Time e 3 ; R a. <br /> Number Location Description Sample Sample F z'> c r,c3 �+ ? s`a5 42 <br /> 1 �0 �.T C'o�a,l led• l°�� 104 �'• C-� <br /> orn�r-f�`c weH ate"-d <br /> l <br /> Relinguifhed by: <br /> Date/4iu3p/0-'TfEReceived by: -Datel Q--Time �' S <br /> Relinquished by: Date Winae Z'60 Received by: I Date Time <br /> 77-71T � <br /> Relinquished by: Date Time t�Received by: Dat,��Time f <br /> PRECISION ENVIR.O-TECH 545 E. Cleveland,Suite A* Stockton CA 96204*Telephone(209)462-0892*FAX:(209)4G2-7935 <br />