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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING I 1 ' / <br /> n �— Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: /I t/1 VI rGr1 Ml :) �tQ Sampler(s): h a n� n a• ,_u — <br /> �� Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:_ Time: QA/QC Q report required: yes X no <br /> Address: Time: Mileage: If yes, To: Staten�Client Other <br /> Lab number: pc S-A6 <br /> Phone: a <br /> s - x <br /> m <br /> FAX: <br /> / /� nn g a m l g z 4�IV <br /> Project name F <br /> 4,0 <br /> a .7 01 <br /> p (� �+ o SFA 9 <br /> Contact person: ��( v e 5d5g = m o a`° <br /> SAMPLE / d 'gs S c l� 1 ci.Gv <br /> � P •fie + N � 3 � � 41 „ •� a v'' <br /> Sample llate Time ° g ,$ ¢, m <br /> Number Location Description sa le Sample EE 9- 33_� i �d <br /> U <br /> /.vw1< WES T /` i G' sur S x x x <br /> MT x �c <br /> Relinquished by: Date Time Received Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, St. Suite A*Stockton CA 95204 *Telephone(209)462-0892 *FAX:(209)462-7935 <br />