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PRECISION ENVIRO=TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS WI REPORT INFORMATION <br /> Rush Analysis: 5 Days 2 Days 24hrs <br /> L <br /> Client: Sampler(s)- <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date: Time: QA/QC report required: yes- no <br /> , <br /> Address: Time: Mileage:7If yes,To: State Client Other <br /> 77 <br /> Lab number: <br /> Phone: "_r <br /> 0 <br /> FAX: " 6 0 .5 <br /> z <br /> 0 <br /> 0 <br /> Project name: <br /> E5 <br /> 5 E_5 A z <br /> Contact person: 0 <br /> 00 <br /> z <br /> ;:� -4 V g g, <br /> 3 a3 E5 <br /> SAMPLE INFORMATION Cl) <br /> Cn <br /> Sample Date Time <br /> 0 <br /> _' <br /> cooP, GO <br /> Number Location Description Sample Sample <br /> z> <br /> I A <br /> 7777 CUSTODY <br /> Relinquished by: Date Time Received by: DateTime <br /> Relinquished by: Date TimeReceivedby: DateTime <br /> IRelinquished by: Date Time Received by: DateTime <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2 * Stockton CA 95210 *Telephone(209)477-8105 FAX: (209)477-8148 <br />