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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS IINFORMATION <br /> Client:� cY,W� ASS Sampler(s): A (-)L,K OOC�C. Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> _T� Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:_ Time: @A @C report required: yes no <br /> Address: 7-2 } vS LN• Time: Mileage: If yes,To: State _Client _Other <br /> Lp JL; q Say}p Lab number: <br /> 1c'(t6 _ol <br /> Phone: ;'O I <br /> FAX: e a x <br /> Project name: <br /> e e N F z <br /> Contact person: Ac a g z z <br /> �� � aaa <br /> � <br /> SAMPLE INFORMATIONd go„ = <br /> Sample <br /> Number saDmple STamimpele zea n Re <br /> Location <br /> a U <br /> 1 1�1 �rt �r � 1tk, GE . 32 - iz : aG k <br /> I IN 01 CUSTODY <br /> Relinquished by: Dated Time Received Received by: Dat o3 Time <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane, Suite B2 * Stockton CA 95210*Telephone(209)477-8105* FAX:(209)477-8148 <br />