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• �• • � • • • • • s • • • • 99 . 0 <br /> PR ISION ENVIRD TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Rush Analysis 5 Days _2 Days�24hrs <br /> Client /i tCn Sampler(s) ►71l1�' yl rto 1 <br /> Subject to surcharge <br /> Customer Number <br /> _ n Comp Sampler Set Up Date — Time QA/QC re ort required ye <br /> s no <br /> Address <br /> Time Mileage If yes,To State - Client Other <br /> -_� P A C?52& f _ Lab number JK I S 7 . 02— <br /> Phone- <br /> FAX <br /> 2.Phone- <br /> FAX <br /> c� kA 3 o d q <br /> Y <br /> Project name <br /> Contact person ;�Jc _,_ U o m V <br /> z <br /> W <br /> x Wm <br /> U moa t7 d v^v, U �b <br /> �I SAMPLE INFORMATION <br /> e � <br /> Sample Date Tame d <br /> Number Location Description Sample Sample P 2° a � 3 - U <br /> il2-I 2:14S <br /> MAN-21 611 X <br /> I- <br /> 7( <br /> 3 <br /> f�U-31 I I I I <br /> -� 12J A.u <br /> CUSTODY <br /> Relinquished byOf ate�e Received by Date ime ± <br /> Relinquished by Date Time Received by ate77- Tame <br /> Relinquished by Date Time Received by Date Tame <br /> PRECISION ENVIRO-TECH 545 E Cleveland, St Suite A*Stockton CA 95204*Telephone(209)462-0892 *FAX (209)462-7935 <br />