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CHAIN OF CUSTODY <br /> PRECISION ENVIRO-TECH ANDANALYSISREQUESTDOCUMENT <br /> htt: 11 menu, Precision Lab. Com <br /> CLIENT DETAILS • REPORT INFORMATION <br /> Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: V>n n10E Cr(() Sampler(a) ��, . �E . <br /> �— Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:_ Time:_ <br /> If yes,To: State —Client —Other <br /> Address: Time: Mileage: <br /> Lab number: <br /> Phone: x t° - <br /> FAX: 3 3 <br /> � o <br /> 0 <br /> �Vij ( <br /> V \\ <br /> Project name: R11177 � �k S s �, • „� <br /> e 6 yFa 9 z14 <br /> t\ cw <br /> Contact person: <br /> of z ym z oSAMPLE INFORMATION <br /> Q T7 w a <br /> Q <br /> Sample Date Time �EE �-.-0 <br /> Number - Location DescriptiOII Sample Sample F• z� a m� w w ��> U - <br /> 1 35 16r per IS x x x <br /> ) _ I.,5Vf x X X <br /> h <br /> rI I WF1 CI t'J I <br /> l � <br /> CUSTODY1 611 D10 V.1 k4l <br /> S \ r/',,Time <br /> Relinquished by: Date Time Received by:'-- Date ' <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> P ...- * FAX:(209)462-7935 <br /> RECI��SI NVIRO-TECH 2040 E.HardingWaySuite B Stockton CA 95202 Telephone(209)462-0892' � I , � <br /> : . . * * <br />