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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS 1 ' 1 <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: bi UrSampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: 1 a Q \\rJ • ke—We-manTime: Mileage: If yes, To: State Client Other <br /> Lod CA- 91 S--14 1 Lab number: 3 1— 0 <br /> Phone: (0bt3 <br /> s � u <br /> FAX: (a a�1 3�'-f� — O"la3 _ m o A <br /> c? �; c�3 0 ,� W # <br /> w 2dd a <br /> o m.w v cC4 <br /> Project name: y g Q <br /> Contact person: �"A <br /> z � s z ° aCd <br /> a3 " <br /> � � <br /> • ' INFORMATION �E a wok ^�+ 0 <br /> Sample Date Time <br /> Number Location Description Sample Sample z> a w d a U <br /> �9 C l is 31 2-* G <br /> 77777 CUSTODY <br /> Relinquished b Date 160kime .0 ;-'9 Received by: Dat(1*LTimed. <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane,Suite B2* Stockton CA 95210 *Telephone(209)477-8105*FAX:(209)477-8148 <br />