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PREA510N ENVIR -TECH <br /> CHAIN OF CUSTODY <br /> m 19 = = = = =H <br /> AND ANALYSIS REQUEST DOCUMENT <br /> SAMPLING77I]ENT DETAILS : ' ' 1 INFORMATION <br /> Rush Analysis 5 Days —2 Days_24hrs <br /> Cll.ent• Sampler(s) <br /> Subject to surcharge <br /> Customer Number /-905 - Com Sampler Set U Date — Time QA/QC report required yes no <br /> ! P P P <br /> a / l�f W If yes,To State CIyent Other <br /> Address. 1 �'F �' �'YtG Time Mileage _ it <br /> Lab number Z E �16T r����'�,/ •3 <br /> Phone <br /> ti P <br /> 6 <br /> FAX �3 a � <br /> a a. G.. m o A � C►r' � v1 <br /> _ .9 o z00 <br /> x <br /> Project name.lJi '�'"►""► -3 � � d ��3 �' � � m, N z <br /> 0 <br /> ( J� oFg A ° z W 9� <br /> Contact person z b z o - <br /> m <br /> 9AMPLE INFORMATION U2 A2� <br /> Sample Date Time a a a 3 ro <br /> Location bCStIOri Description <br /> Sample Sample P z° a 3 w U <br /> � M�� 3- 1 � o� i�l:r� 1►r N� 3 �` <br /> .2 MW 3-2- -2/g/0019 .20 1✓ NW 3 <br /> 3- 3 P NW <br /> 7hnCUSTODY <br /> 76L <br /> Relinquished by Date Time Received by Dat we_igime3-�- 01 4 s <br /> Relinquished by Date Time Received by Date Time <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 />