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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS <br /> M���7 REPORT INFORMATION <br /> Client: 7Sampler(s): 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 /> Address: Time: Mileage: <br /> If yes,To: State Client Other <br /> Lab number: <br /> Phone: _ <br /> FAX: <br /> sem = z �x <br /> Project name: <br /> z _ <br /> Contact person: F z y b M <br /> m y z o b <br /> Q zCr <br /> 333 m o �v <br /> SAMPLE INFORMATION <br /> Sample Date Time a z¢ w N x <br /> Number Location Description Sample Sample z'° a. F a a J <br /> 7777 y: Date Time Received by: DateTime <br /> : 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 />