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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> CLIENT DETAILS ANDANALYSIS REQUEST DOCUMENT <br /> rr� <br /> Client: Ji G��/ l?� Iiueh Analysis: b Days _2 Days_24hrs <br /> Sampler(s): . F.v r <br /> Subject to surcharge <br /> Customer Number:_: C� <br /> Comp Sampler Set Up Date:_ 1�me: QA/QC report required: yes no <br /> Address: I`'i V,i . �"t�v tclt k• <br /> Time: Mileages if yes,To: State Client _Other <br /> I i ! r ' <br /> � ' `f � Lab number: 5� � .v I:� •4 <br /> Phone:_ G 1 <br /> FAX ' QA <br /> c� ? 3 <br /> Project name: P <br /> o> <V <br /> Contact person: C A f �.,•. z ^ rn" 2 <br /> RQj <br /> `j(/�1T •moo <br /> G U - K•K �! �� y jib (j �'4 + <br /> s a1 c� <br /> r I.Acation Description Date '!time y w <br /> Numbe <br /> Sample Sample <br /> 4 lie <br /> i <br /> Relinquished hy: �? Date�� '• %G <br /> Time_' Received b D 5 >1 _ <br /> y— , Date f-+'{ ! T1me7777 •r'r` <br /> Relinquished by: Date Time Reoeived by: I Date. Time <br /> Relinquished by; Date 719ne Received by: nate Time <br /> PRECISION ENVIB.O-TECH 7743 N.Fest lane,Suite B2 *Stockton CA 95210*Telephone(209)477-8105 FAX:(209)477-8148 <br />