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QREEISION ENVIRO-TEE I CHAIN OF CUSTODY <br /> A'VD'VVr3LYSIS REQUEST DOCUIJIENT <br /> GLIENTE � _ <br /> + . <br /> I REPORT <br /> Client:_ \�`� Sampler(a): i Rusb Analysis: 5 Days _2 Days_24hrs <br /> 2 <br /> Customer Number: $object to surcharge <br /> _ _ _ -- <br /> Comp Sampler Set Up Date:` Time: QA/QC report required: yesno <br /> Address: <br /> —- Time: Mileage: if yes,To:State Client Other <br /> Lab number: <br /> Pbone: o } <br /> FAX: Zi o yA <br /> qua o <br /> e p' gm c 0 <br /> Project name:_ , ( S .< 1 a __ ` �t01 m x <br /> - <br /> ti1ti , �S 3 v wq A u z �j G <br /> Contact person: �,lam <br /> m y o ¢ � j <br /> Hq <br /> a r^SAMPLE INF]FORNIATION <br /> �. � <br /> Sample J�- .!Number Vocation Description Date Time 4 � o '� _i yy <br /> Sample Sample Z° m Q <br /> 15 <br /> -- Relinquishedby r•i <br /> Date CS Time S : �Received by: �__✓ ., 1`\-_ � t;. <br /> DateIiTime l ) 1 SL <br /> — -- Relinquished by: I Time Received by: <br /> Date_ Time <br /> - --- Retingtii3hed by: _ Date Time _Received by: <br /> Date Time _ <br /> PRECISION ENVIRO-TECH 7743 N. West Lane,Suite B2 x Stockton CA 95210*Telephone(209)477.8105*FAX(209)477-8148 <br />