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I I I I 1 I I <br /> PRECPALIN ENVIRU-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS INFORMATION <br /> 14ViJn! °'" Rush Analysis: 5 Days _2 Days_24hrs_ <br /> Client: �- .%:'`._;:; ' Sampler(s): . <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time:_ QA/QC report required: yes_ no <br /> Address: Time: Mileage: y <br /> L.1 ` ..j If es,To: State _Client _Other <br /> i, i_"i) 1 \ } I Lab number: <br /> Phone: ;} ,� <br /> s _ x <br /> V a s m 5 <br /> FAX: <br /> 3. 9 V q <br /> Project name: ✓-'t."t'v' y • A <br /> ro mm <br /> a Q <br /> Contact person: f` 5 V M a <br /> zSAMPLE INFORMATION <br /> tY 9 r3 a m .rj <br /> Sample Date507--p-e. <br /> Time < 4 <br /> Number Location Description Sample sample ' z°> ad,° v <br /> Relinquished by -!" Date Time a r_�.t Received.by r Date Time <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 />