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PRECISION ENVI � CHAIN OF CUSTODY REMOVED <br /> L7 7"ECH �vn� <br /> ANDANALYSLS REQUEST DOCUMENT APR 9 1 7005 <br /> CLIENT DETAILS <br /> t <br /> i } � . <br /> Client: {j Q, Sampler(s}: 1 Rush Analysis: 5 Days _ bays d s <br /> � _. 1('�� _y�_�' <br /> Customer Number: — <br /> Subject to surcharge <br /> Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: � �• <br /> Time: Mileage: If yes, To: State Client Other <br /> LIDl Lab number: '109 2-11 t• - Q f - � •f <br /> P one: -Wl '7p <br /> FAX: J a A , <br /> z E+i Eli <br /> jr - <br /> Project name: <br /> N <br /> ca <br /> o <br /> ec 3 <br /> a <br /> Contact person: 61AJ P7o `L <br /> R <br /> SAMPLE INFOR?VIATIONa <br /> — c F r F m - 'c' ,� <br /> Sample = = J �. ° <br /> Location Descriptioaa Date Time � 'o � <C � <br /> Number Sample Sample F z a <br /> I F I <br /> �� t C k� � 7 v' ✓ ✓ <br /> ! CUSTODY ++ <br /> Relinquished by: Dat Time 16/0 Rece' ed b / z ��/ <br /> y: ate Time <br /> Relinquished b �? <br /> q y= Date Ti777me Received by: Date Time <br /> Relinquished by: Date Time Received by: Date <br /> Time <br /> PRECISION ENVIRO-TECH 7743 M West Lane, Suite B2 *Stockton CA 95210 *Telephone(209)477-8105 FAX: (209)477-8148 <br />