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PRLZ151ON ENVIRO-TECH CHAIN OF CUSTODY _ <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING 1 ' / <br /> �J,N Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client:�M&2q (l2! kvj&� Sampler(s):1 AC1iyG /,f"VY <br /> Subject to surcharges <br /> Customer Number: QA/QC report required: yes � no <br /> Comp Sampler Set Up Date:— Time: . / <br /> Address: �y�Z EL j ,"V or, QSVE If yes, To: State Client v Other <br /> Time: Mileage: <br /> IJP 5 Z-O Lab number. Q 2-0 <br /> g — <br /> Phone:-(2,05) y(aa- a< LY <br /> S x � <br /> 3 y <br /> FAX: ( Z0g ) 9 y I- 29 90 - A <br /> c? � <br /> m4 ° <br /> a w A 1JF zProject name: F , Z:Zp -teContact person: �-(i4 y'N6 Z13.,C zo "�SAMPLE INFORMATION <br /> Sample DateTime d c wNumber LOCatlori DeSCrlPtlori Sample Sample z' <br /> /:004-Me -D6 <br /> ST�c _ av 139 O.-T-6,47 <br /> a L& <br /> # 55-117 900 <br /> ICUSTOD / <br /> 7 Relinquished b7-x7= <br /> . _ Dat O Time f/ I Received by`� Dates Z 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 />