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CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> a•wwe.nw•s��ncwn r.o asw. , . n <br /> �✓_•, C1 _ , r,Ief Rush Analysis: 5 Days—2 Day _24e <br /> Client: ler(s): <br /> � Subject SA surcharge <br /> Customer Number: QA,QC report required: yes_au _ <br /> Comp Sampler Set Up Date:_.Time: <br /> Address: -1 r CWe Time: Mileage: If yes,To: State—Client _Other _ <br /> _ <br /> 6d <br /> ( <br /> ' <br /> q Lab number: yjU 29,(a-01-O Z <br /> hone: Wg 367--SM/ s z <br /> FAX: 207 <br /> �s <br /> Project name: � 8 s aaa `� Neai Q' 0 21 <br /> Ily <br /> Contact person: G�e(t cn <br /> c 55 3z3 � is 'o <br /> e= ? S <br /> SAMPLE IN <br /> o, f Asa 5 oo 5 <br /> Sample <br /> Number Location Description Sample Sample �^, i> <br /> 3�t�� Zw�'e(wMN4rJ iZ5 f f JDA P &PJ <br /> 34u*�?n,ke� tiit�! S#Z !v- .v 3r3a G P P Crh1 X X <br /> Relinquished by. Dale imei_.e: _Rawiv y ate����-/,yv!�e •`� <br /> Relinquished by: <br /> Date _Time J Received by Date 'me <br /> ReGngoished by: <br /> Date _Time Received by Date '11me <br /> PRECISION ENVIRO-TECH 545 E.Cleveland,Suite A e Stockton CA 95204`Telephone(209)462.0892° FAX:(209)462-7935 <br /> 1 1 1 1 I 1 1 1 1 1 1 l 1 1 1 1 1 1 1 <br />