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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS <br /> 1 <br /> Rush Analysis: 5 <br /> Client:.��11_l..+rtJ � Rh�:..:�'i��, - Sampler(s): y Days _2 Days_24hrs_ <br /> Customer Number: Subject to surcharge <br /> Comp Sampler Set Up Date:_ Time: QA/QC report required: yes no <br /> r <br /> Time: Mileage: If yes, To: State Client--� Other r I Zo 1 X6 —4!9 j`�' ' �i�'"r `'"r� • Lab number: <br /> 'C to O Fr <br /> a 3f ° z <br /> Project <br /> Contact person: <br /> 0SAMPLE ¢ <br /> •a '� z 3�3 � � Ll � � 4 w m <br /> _ ro <br /> INFORMATION <br /> Sample _ Date Time y 6¢ a 09 m N <br /> Number <br /> 1�ijt,:t C:t A'tl .1at�(,Z'i )�,io:II. Sample Sample F z> a m y m j <br /> IN r�-till7 i v u'm� - ZZ) `` * 'S r -7-1-26 Ai <br /> I <br /> i <br /> � �^,ter.•-, r �,Q,q <br /> Receive <br /> Relinquished by: '�- ! Datime fY <br /> a� d <br /> cDRelinquished by: DateTime <br /> Received by: Date <br /> Time <br /> J <br /> o Relinquished by: Date Time Received by: Date Time <br /> v <br /> C:}1: 7743 N.West Lane, Suite B2*Stockton CA 95210 *Telephone(209)477-8105*FAX:(209)477-8148 <br />