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Client:ms,-Tr-4, r4A:tc--As s CeNtv-vc-v--) <br />Customer Number: M • • C- <br />Address. <br />Phone: <br />FAX: <br />Project name: <br />Contact person: 2099432656 Sampler (s): I3'1•3 <br />Rush Analysis: 5 Days 2 Days 24hrs <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: State Client Other Time: Mileage- <br />Comp Sampler Set Up Date:_ Time: <br />SAMPLE INFORMAT <br />Location Description <br />PO <br />'Cime <br />Sample <br />z!ov Ca-? IR Catherine Hall Date <br />Sample <br />/ 540 7 <br />Sample <br />Number <br />Relinquished by Date Time Received by: Date a .4. a:rime cA) <br />Relinquished by Date Time Received by: Date Time <br />Relinquished by: Date Time Received by: Date Time <br />'AMPLING <br />RE, 1510N ENVIRO-TECH CHAIN OF CUSTODY <br />AND .,'LVALI7SIS REQUEST DOCUMENT <br />PRECISION ENVIRO-TECII 545 E. Cleveland, Suite A Sto .sn CA 95204 Telephone (209) 462-0892 " FAX: (209) 462-7935