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PRECISION ENVIRD—TECH CHAIN OF CUSTODY <br /> .AND ANALYSIS REQUEST DOCUMENT v <br /> DETAILS REPORT INFORMATION <br /> Rush Analysis: 5 Days 2 Days_24hrs <br /> Client: 0. ��'�-n-�'��° fi �f�; Sampler(s): �ror1 —" <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA/QC re ort required: Yes no <br /> Address:_ qOZ ���� �� �', Time: Mileage: If yes, To: State Client Other <br /> Lab number: <br /> Phone: .3� '7 — 3_7z/ <br /> y x <br /> jM <br /> FAX: <br /> 333 �— 0503 �, � Do13 �. x � A <br /> a � " sa O Q y mg <br /> s� = z o F+ mx <br /> Project name: 6—t1� -r P/ I'- r atio V C <br /> z <br /> Contact person: <br /> cc <br /> 41 <br /> SAMPLE INFORMATt'ON <br /> Sample Date Time ¢ w y^ y <br /> Number Location Description Sample Sample <br /> I ��.•f . w�� X23 e:�s r <br /> r � CUSTODY <br /> Relinquished by: Date �Z/ Time 9 3 to Received b atj�y Time g <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 w Telephone (209)462-0892 'r FAX: (209) 462-7935 <br /> s <br />