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CHAIN OF CUSTODY <br /> PRECISION E v V I R O'A'T E H AND ANALYSIS REQUEST DOCUMENT <br /> hit: }/ wwrw Precision Lab. Com <br /> ' <br /> REPORT <br /> CLIENT DETAILS 1w lo 1 w R <br /> j� _ ,, Rush Analysis: 5 Days _ 2 Days_24hrs <br /> 1� d �� �r ��4���n'�V Sampler(s}: f � 1 E' �r�.,. <br /> Client: Subject to surcharge <br /> Customer Number: Comp Sampler Set Up bate:— Time: QA/QC report required: yes no <br /> If yes,To: State Client Other <br /> Address: Time: Mileage: <br /> Lab number: 7(1 r <br /> Phone: x <br /> FAX: <br /> �j � o •G v c� \ ,C <br /> Project name: <br /> � ) l <br /> Contactperson: ti r�� 1 V r C fie, 1 S�lv'! �g - — ~ U <br /> P z N �_ © W d� r � 4 a <br /> SAMPLE Date Time a C.¢ c5 ja vl x ! "a <br /> Number ,0 U <br /> Number Location Description Sample Sample z° 0. ? �? P. <br /> � <br /> x' <br /> t <br /> F FF <br /> 1 ! 1 <br /> Relinquished by: Date Time rived by: <br /> L f 0 Date ime <br /> Relinquished by: Date -Time- Received by: Date Time <br /> Relinquished 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 />