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PRECISION ENVIRD-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> iCLIENT DETAILS SAMPLING ■ . <br /> Client: D I Lky c m UttH <br /> Sampler(s): M iY C Rush Analysis: 5 Days _2 Days_24hrs_ <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:. Time: <br /> GJx 2 V <br /> �. a . <br /> Address: Time: Mileage: If Yes,To: State Client Other <br /> Lu01 , GJ - 01, 2-4 i Lab number: <br /> Phone: 01�Xl <br /> 2 3 `� <br /> FAX: 1 .) 74 - x q <br /> 6 <br /> o > <br /> Project name: F Q o a <br /> x. <br /> �y j'1� � <br /> Contact person: 3 p t6 0m <br /> v <br /> flF z z o <br /> m <br /> �a zC3 � C8 <br /> SAMPLEINFORMATION rn E a q Q <br /> Sample Date Time d Location Description Sample Sample z <br /> y <br /> mal}IW+ Gel )V. 0 I90 " 'l� � ? i� <br /> 777 CUSTODY <br /> Relinquished by: Date Time Recei erd by;.. � Date±f/ /Time 124 0 <br /> . _ <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> -PRECISION ENVIRO-TECH 3935 N. Coronado Ave. * Stockton CA 95204* Telephone(209)477-8105 *FAX: (209)546-7497 <br />