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CHAIN OF CUSTODY <br /> � MMMMMMMM mmmmmmm4rm <br /> PR 151OV ENVIR��-TECH AND ANALYSIS REQUEST DOCUMENT <br /> SAMPLINGCLIENT DETAILS P1 ' INFORMATION <br /> 1 J_ ©C �R Sampler(s) Rush Analysis 5 Days'Days_24hrs <br /> Client a�c- �'-- <br /> Sublect to surcharge <br /> Customer Number Comp Sampler Set Up Date — Time QA/QC report required yes '�!_no <br /> Address V b. r G e �_ �_ Time Mileage if yes, To StateChem Other <br /> / 5-215 -01 Lab number 0. ©-3 <br /> Phone. `T ' G la U r <br /> FAX CKI! �� _ <br /> w ecce z o �� <br /> Project name m A 6 ° v �, <br /> a o W <br /> t V ran u z <br /> Contact person �I r��P,, L L i U v; ° o <br /> QH d b z M <br /> o o <br /> a 333 x e on v <br /> z d 0 d L0SAMPLE INFORMATION <br /> col <br /> DateSampIe TimeLocaton Description Sample v Nx <br /> q� <br /> Sample z> <br /> �tw` — �•5t BW <br /> -33— �c C7q � G t/ <br /> L s, 09 Gt X <br /> OD <br /> Relinquished by ( Date1ime Received by Date? img}� <br /> ti <br /> Relinquished by Date Time Received by Date Tune <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 />