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wl"� WWI <br /> PR 1SION ENVIROmTECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORT INFORMATIONCLIENT DETAILS <br /> Rush Analysis 5 Days _ 2 Days_24hrs <br /> Client t Sampler(s) � tjwnylr —riviA n <br /> '�JJ Subject to surcharge <br /> Customer NumberQA/QC report required yes no <br /> �i Comp Sampler Set Up Date , TTimeAddress _ 310n ) EJfl�t'7''OD Time Mileage If yes, To State Client Other <br />� n <br /> (,A qco-atj Lab number v <br /> Phone. x <br /> m A <br /> FAX G 3 x d <br /> m a G a0 z O <br /> F P4 <br /> m o > b C <br /> m � � <br /> Project name �(1� �- � �; ��A 5 <br /> o c7 a n z VIP <br /> Contact person _ )���rr s 6hapc o ° m �'� <br /> F z � • z o �, � _. <br /> IM <br /> m .� z W a a <br /> SAMPLE INFORMATION11 <br /> U1 °F a "�, ° �' <br /> o � � � CR,� O <br /> Sample Date Time a ° 3 `� d x O z <br /> Number Location Description Sample Sample z y ?� �? <br /> f11,Jit, 3:00 A I �o <br /> -3` L f LO <br /> CUSTODY <br /> Relinquished by Date y4*zme .�w Received by Dat tme <br /> Relinquished by Date Time Received by Date Time <br /> Relinquished by Date Time Received by Date Time <br /> PRECISION ENVIRO-TECH 545 E Cleeland, St Suite A* Stockton CA 95204*Telephone(209)462-0892*FAX (209)462-7935 <br />