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0 MME <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING 1 1 <br /> Client: -A\ v Sampler(s): \ Rush Analysis: 5 Days _ 2 Days_24hrs <br /> _ C��Gc�I�U � <. <br /> Subject to surcharge <br /> Customer Number: _ QA/QC report required: yes no <br /> Comp Sampler Set Up Date:_ Time: <br /> Address: 93CY V 10 Time: _ Mileage: If yes,To: State r Client Other <br /> LpXAi C�,I��p(nto� qS��_1 Lab number: 11DC)5j() <br /> Phone: (ZNq 33N - "13 0 <br /> FAX: a a q <br /> m�a <br /> x Z v <br /> Project name:Z536 A-4-pA RAC MYVC Sub s <br /> is <br /> Contact person: 6fat ti 1�c�rJ �3 d g m �; :� <br /> CV <br /> 6 z <br /> SAMPLE INFOItMATION <br /> Sample Date Time e< a x B Q y <br /> Location Description 0 <br /> Number Sample Sample z> 0. a s m J <br /> (PG l Z) 5/ 1 13:00 Gr i>e'r ►f <br /> 77 CUSTODY <br /> 2 <br /> Relinquished by: it Cad li u 6ndd Date y 1 Time !3' 2 Received by: Date lime <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)477-1 Page 6 of 11 <br />