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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> SAMPLINGCLIENT DETAILS ' • 'T INFORMATION <br /> r' 7WT Rush Analysis: 5 Days 2 Days_24hrs_ <br /> Client: 1/I'a o. 114f" S6) ASSOC • Sampler(s): � ��D�� <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: `l t 0"1 t-0Time: Mileage: If yes,To: State Client Other <br /> Z Lab number: <br /> 'hone: <br /> U <br /> S m epi <br /> FAX: a 3 oA <br /> a w a z 6 L4 u <br /> r0 ami <br /> O N <br /> Project name: + :`_: {��; � A o = o <br /> F <br /> W <br /> Piz) <br /> Contact person: �. i._ii t L- E� 5 <br /> U C F c Y Oro O <br /> z z - � 21 g <br /> SAMPLE INFORMATION <br /> `o cj3 ^ 0 <br /> Sample Date Time v g a w <br /> Location Description '0 3 3 <br /> Number Sample Sample z> U <br /> PD <br /> Relinquished by:' '/ - - ate `ij? Time�1A%ceived by: /0 <br /> C� _. Date��fime /Qrs . <br /> i <br /> Relinquished by: Date Time Received by: Date Time <br /> 777 <br /> 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 />