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PREEISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> MW MM" I REPORT INFORMATION <br /> Rusb Analysis:5 Days —2 Days-24hrs <br /> Client: Sampler(s): <br /> �� Subject to surcharge <br /> Customer Number:_ <br /> Comp Sampler Set Up Date:. Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: Slate Other <br /> Client — her <br /> Lab number: &S—?-'?'y—40/y U Zr <br /> Phone: ! <br /> � _ x <br /> b <br /> FAX: >ui i, a A <br /> w n r t5 w <br /> IV r <br /> Project name: Y 3 4 <br /> g z�a z E o Z <br /> a <br /> Contact person: <br /> a � � <br /> v U. TJ LO <br /> s_ WN tell <br /> d gs} <br /> a <br /> mple ueto Timeon Description uampeemplinquishedDate <br /> �Sx <br /> C} <br /> by �Timej.'%. Received by- DzitCe me <br /> Relinquished by: Date Time Received by Date Time <br /> Relinquished by.--_--_---,__bete _. — .Time—. — _Received by:---- --_ — — , ,Data,---Time — <br /> PRECISION ENVIRO-TECH 545 &Cleveland,St. Suite A" Stockton CA 95204*Telephone(2D9)462-0892 s FAX:(209)462-7935 <br />