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PRECISION ENVIRH-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT <br /> U-91 REPORT INFORMATIONl <br /> Client: D'00r) Sampler(s): Jue' Mor�t o Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Subject:to surcharge <br /> Customer i�Tumber: � <br /> Comp Sampler Set Up Date:_ Time: QA/QC report required: yes no <br /> P.0- <br /> Address: r•y• 2 o� 2 1 �O Time: Mileage: If yes,To: State Client Other <br /> Labnumber: �/I/ C" <br /> G' <br /> Phone:_(20`i) 334 - W3 (! I� +i <br /> m <br /> FAx: Cze 33`!- 0_�23 3 , <br /> � G y <br /> Z <br /> Project name: 1123 J cAO 1Z'%e RD <br /> � N <br /> Jue( Mon}quo d w —te <br /> Contact person:_ �mcnfQ�o�o�:llo.,w,,1 o v o <br /> SAMPLE ■ w <br /> • O H � o m � <br /> Sample Date Time <br /> Number LQC�ltlllt7i .I�r'SCTFp f'i.�:C7 ¢ w 3 d x ~C <br /> Sample Sample 1 z' <br /> We Il duce+ <br /> 44 <br /> I CUSTODY <br /> I I ► I <br /> I I I <br /> I I <br /> I <br /> li <br /> rT Relinquished by: ^'- Datell/Ztdime t2, 6Received ba e Sf +l'ime 12-`� <br /> m t _ Relinquished by: Date Time Received by: F Date Time <br /> 4 <br /> •",Q i <br /> o •� Relinquished by: Date Time Received by: Date Time <br /> cn <br /> 1:'R1!;C.1:S.LUi�T:E1�TVI:CGC1=iThC.f s: 7743 N_West Lane, Suite B2*Stockton CA 95210*Telephone(209)477-8105*FAX: (209)477-8148 <br />