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u CHAIN OF CUSTODY <br /> PRECISION E N V I R II-TECH AND ANALYSIS REQUEST DOCUMENT <br /> hit: 11 www Precision Lab. Co- <br /> REPORT <br /> om <br /> • • • • If,4FORMATION <br /> CLIENT DETAILS <br /> Rush Analysis: 5 Days — 2 Days_24hrs <br /> � � J <br /> Client f/ VA1111 _ (� �� C "n��;'% G. Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> /N) <7 AI1 �� f i.y �i,� If yes,To: State Client Other <br /> Address: LTime: Mileage: <br /> (f�T�l� l- Ky.v �' �f C3 Lab number: <br /> Phone: ���( � /_� <br /> FAX: <br /> Project name:- <br /> Contactperson: <br /> ° c3 333 w z I 1 rco <br /> u \ ` •� `tel y y ,��1 <br /> SAMPLE INFORMATION <br /> Sample Date Time a o 0 U <br /> Number Location Description 5<mplc Saml,le E_ x> a �0 0. <br /> C ` <br /> OD <br /> Lby: <br /> by; Date Time Received by:ft-f <br /> (-f Date_ �Time <br /> Date —Time_Received by: Date_�—.-Time <br /> try: <br /> Date —Time—Received by: Date Tirne <br /> 7-777PTd.TCTSION IsNVIRO-TECH 201011• IIardilig Way Suite B * Stockton CA 95202 *Telephone(209)462-0892 * FAX: (209) 462-7935 <br />