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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> j <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAIL9 =MOM REPORTINFORMATION <br /> / Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Clients p /�Oi> u r,t(7rZ/z ccr� l Sampler(s): VZZF-c: �� �7 <br /> �+L n <br /> Subject to surcharge <br /> ACustomer Number: 67,cc) QAiQ C re q y <br /> Comp Sampler Set Up Date:— Time: <br /> port required: es no <br /> Addre �B' : Time: Mileage: If yes,To: State Client —Other <br /> �.. <br /> r <br /> Lab number: L1 6� <br /> Dhone• o <br /> FAX: h : <br /> „ : a <br /> r:+� O x OD <br /> 1 4 <br /> _ F W <br /> p V § 1Vzt <br /> W V <br /> Project na i l �01 a V F O ee• N �y 1 <br /> W f�- <br /> g N V <br /> Contact on: <br /> 6i .gg F Z y a Y W n <br /> a c`� <br /> • INFORMATIONLE �• �'� Z a 9 J > n � � U C <br /> 9 pl , _- _;i" tDa Time B <br /> Loc ion Description a H - r�N o <br /> N beC Sample F z'> i > U <br /> g Z MTy� �iqi r i�, tt y ; v cel ., 4i 5 a- �I 3v <br /> Vyl I <br /> CUST <br /> OD <br /> Inquished by: .±'' Date Time Received b ( 9 �l/j ' 1-••'"�`' Y� Date Time <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, St. Suite A* Stockton CA 95204*Telephone(209)462-0892* FAX:(209)462-7935 <br />