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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT ' ' 1 ' INFORMATION <br /> / //1� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client:S� r-sI p6^1/,c. ,ft6 �&,X" a4.1°' SampleddA&C:r(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> ,1 Comp Sampler Set Up Date:—Time: <br /> Address: l yl Z &� PPV44 iC i VLA U 7 5 If yes, To: State Client '� Other <br /> Time: Mileage: ! <br /> 77j�jC(7j 04- 9 S U Lab number: �O 10120 DQ <br /> ^ 0 1 <br /> Phone: Zv 9 q (p- g41.tf <br /> AV <br /> FAX: Z�`1 ) �l� l- L94o qua - o <br /> s ° o z o 2� tix <br /> Project name: <br /> N r�u H <br /> Contact person: 11( /GN�f�e ° <br /> T z zSAMPLE INFORMATION <br /> o w O co <br /> Sample Date Time <br /> Location Description Sample Sample z=o m <br /> o <br /> m a r p U <br /> SMOG HO& CvAJ &')SANE (o•IZ.07 7.ySA Cs I P imp -- Q <br /> • -CUSTODY <br /> SRR aus - o� Z '3o2 C1 <br /> NR SSS Relinquished by: Time Received by:_ Date L Time <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2*Stockton CA 95210 *Telephone(209)477-8105 *FAX: (209)477-8148 <br />