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PRECISION ENVIR[]-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING <br /> REPORT INFORMATION . <br /> /TG'? <br /> y� t� Rush Analysis 5 Days <br /> Client Sampler(s) 2 Days_24hrs <br /> 67 Subject to surcharge <br /> Customer Number <br /> Comp Sampler Set Up Date _ Time QA/QC report required yes no <br /> Address Time Mileage Ir yes,To State Client Other <br /> Lab number <br /> Phone _ <br /> U <br /> 7 _ � <br /> FAX <br /> p <br /> z <br /> IYIAP' r er y Y o Q 2 <br /> Project name C`ZL 1 <br /> ti Q <br /> 01 f o <br /> Contact person <br /> v +33 C: b0OCL <br /> SAMPLE INFORMATION <br /> V a <br /> Sample <br /> sRate imeLocationDescription <br /> -oNumber Sample Sampl <br /> a o <br /> z> a 3 e C U <br /> 0 LZ CA, 10 z 61--__ <br /> i <br /> I , <br /> CUSTODY <br /> Relinquished by DatA71 Time `r__,., Recexv by Date me ZA <br /> RelinRelinquished b <br /> q y / Date Time Received by Date Time <br /> Relinquished by Date Time Received by Date T e <br /> P SION ENVIRO-TECH 545 F Cleveland, St Suite A* St n CA 95204 * Telephone(209)462-0$92 1FAX (209)462-79 <br />