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PRECISION ENVIRO-TECH <br />Client: dAt-1 F62N ( A '[Al, c. UA)ES <br />Customer Number: CSL eT) <br />Address: <br />Sampler (s): D � <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Comp Sampler Set Up Date:— Time: <br />Time: Mileage: <br />Rush Analysis: 5 Days 2 Days 24hrs <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: State Client Other <br />Lab number:���% <br />Phone: <br />d <br />C3 <br />3 Y <br />m <br />P <br />FAA: <br />C7 <br />Q• <br />e > <br />N <br />� <br />� G <br />Project name <br />E5 <br />A <br />. <br />3 <br />N01 <br />o <br />o <br />C7 <br />F LI <br />1 <br />m <br />n <br />z <br />person: <br />E <br />` <br />a <br />x <br />Cm – <br />�'Contact <br />�0. <br />6 <br />rig <br />d <br />v� <br />F <br />z <br />z <br />„ <br />a <br />; <br />ti F m <br />a <br />z <br />� <br />z <br />0 <br />CU <br />Cc <br />W - <br />SAMPLE INFORMATION <br />o <br />v <br />O <br />0 <br />x �,a <br />U) <br />= <br />i <br />N <br />Sample <br />Location Description <br />Date Time <br />Sample <br />o <br />5¢ <br />o> <br />a <br />w <br />rn <br />v <br />w p ? <br />Number <br />Sample <br />z' <br />0L <br />x <br />ICUSTODY <br />Relinquished by: Date Time Received by: Date ime <br />Relinquished by: Date Time Received by: Date Time <br />7777 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 />