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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS &MAVA U911CO-4REPORT 1 <br /> / Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> /� �f Sampler(s): !/ w �2/ <br /> Client: AdV. GeU�j r)yl rion Wyl )a– Subject to surcharge <br /> Comp Sampler Set Up Date:— Time: QA1QC report required: yes no <br /> Customer Number: Time: Mileage: If yes,To: State _Client —Other <br /> Address: Lab number: <br /> g <br /> Phone: a <br /> FAX: W x <br /> F <br /> k o <br /> Project name: Q <br /> a o cx� o x <br /> Contact person: b n 2 W <br /> 0 Z <br /> W s <br /> SAMPLE <br /> INFORMATION <br /> Sample DateTime <br /> Number Location Description Sample Sam le z ei � `° = ( C8` U <br /> 1 1414-,*1 10.11 10.3516- Mfl 15<1 � <br /> 36 a &f T1Se; t <br /> OD <br /> Received by: Date Time Received by: Date Time <br /> Relinquished by Date _Time Relinquished by: Date Time <br /> Received by: Date Time Received by: Date Time <br /> PRECISION ENVIRO•TECH 2040 E. Harding Way Suite B *Stockton CA 95202*Telephone(209)462-0892*FAX:(209)462-7935 <br />