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CHAIN OF CUSTODY <br />PRECISION ENVIRO-TECH AND ANALYSIS REQUEST DOCUMENT <br />CLIENT DETAILS SAMPLING REPORT INFORMATION <br />41V/II, Rush Analysis: 5 Days _ 2 Days 24hrs <br />Client: C4Z lT7 )1X Sampler (s): ""`� <br />--� Subject to surcharge <br />Customer Number: G:ZL-CO <br />Address: <br />Phone: <br />FAX <br />Comp Sampler Set Up Date <br />Time: <br />Mileage: <br />V <br />3 m <br />O <br />a cm ❑ z <br />s <br />U i E�., Ga = N ON <br />Project name: � ' ���'� /Q I <br />v <br />Contact person: <br />Sample Location Description <br />Number <br />'elleIre, <br />Time: QA/QC report required: yes no . <br />If yes, To: State Client Other <br />Lab number: & 7777AO <br />Q <br />� <br />c? <br />9 <br />0 <br />-- <br />a <br />z <br />FJ <br />0 <br />v� <br />�O z <br />W <br />O � <br />�' <br />x <br />O <br />Ca <br />4. co <br />0 0o y a� <br />eo <br />m <br />v <br />3 <br />O <br />Nx <br />Daterq'�� <br />o <br />mpale4(c',P <br />0> <br />1i�06 <br />q <br />POO <br />- <br />Time: QA/QC report required: yes no . <br />If yes, To: State Client Other <br />Lab number: & 7777AO <br />Q <br />� <br />Q <br />E7 � <br />FJ <br />0 <br />v� <br />�O z <br />W <br />O � <br />d <br />Ca <br />4. co <br />0 0o y a� <br />GO U <br />7777Relinquished by: Date Time Received by: r Date ime <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 />