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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT SAMPLING REPORTINFORMATION <br /> Client: Rush Analysis: 5 Days _2 Days_24hrs <br /> Sampler(s): — <br /> Customer Number: <br /> Subject to surcharge <br /> �, _� <br /> JJ�� J �� �y� Comp Sampler Set Up Date:_ Time: QA/QC report required: yes— no <br /> Addres [J60 (RO V I �(O _ Time: Mileage: If yes,To: State_Client _Other <br /> f�l �� /4 Lab number: <br /> Phone: <br /> FAX: ( �(�� 1 �1g 3 — L) 1�0 m03 x _P <br /> Project name: °— vL t x <br /> n <br /> "anContact person: o y <br /> o z AIv z o �� <br /> SAMPLE INFORMATION <br /> Sample Date Time % <br /> Number Location Description S le Sample F z° a <br /> iCUSTODY <br /> p <br /> Relinquished by: DateS 'ime � )a Received by:�� Dat Time <br /> Relinquished by: _Dateime 2 ,e�R�ceived by: Datedll*ime 2& <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)477-8145 <br />