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CHAIN OF CUSTODY <br /> PRECISION ENVIRO-TECH gNDANALYSISREQUESTDOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time:_ <br /> If yes, To: State Client —Other <br /> Address: Time: Mileage: (! <br /> Lab number: <br /> one: m <br /> FAX: co <br /> A a s x a l� x <br /> JS <br /> Project name: p U y o W G 2 <br /> Contact person: I U Y1 d °g JJJ� <br /> m �� x ym� x A4 <br /> (3.Goeu � <br /> 3 °3 £aa a tii ' <br /> 77_� <br /> Date Time <br /> ion Description Sa le Sample Z> <br /> Zo <br /> No <br /> x <br /> •D <br /> Relinquished by: Date Time I ppm Received Date �U Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 2040 E. Harding Way Suite B* Stockton CA 95202*Telephone(209)462-0892*FAX:(209)462-7935 <br />