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^� CHAIN OF CUSTODY <br /> -PRECISION ENVIRO-TECH 96:4t�_ ANDANALYSISREQUEST DOCUMENT <br /> REPORT • • <br /> DETAILS1 CLIENT "� / Rush Analysis: b Days _2 Days_24hrs <br /> Client: <br /> �O EN V1 ae6 /YARN/ Sampler(s): � 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 /> i <br /> � G <br /> rne• a q <br /> � m z 00 <br /> FAX: o <br /> �(YrI f�Ir174� �" s <br /> Project name: <br /> O <br /> Contact person: ll s e s ' � �• m$ 3 <br /> z 3 z S <br /> • `s ��a E <br /> Date Time 9 <br /> Sample o <br /> Location Description Sample Sample z> a �o <br /> Number <br /> � _ � ,l3 /•� Gr A•9 <br /> z:,- s <br /> Date ' Time Received Date Time <br /> Relinquished by: �- <br /> Date _Time Received by: Date Time <br /> Relinquished by: <br /> Relinquished by: <br /> Date _Time Received by: Date Time <br /> ne(209)462 0892*FAX:(209)462-7936 <br /> PRF.CTSION ENVIRO-TECH 2040 E.Harding Way Suite B*Stockton CA 95202*Telepho <br />