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V I I Y I I Y I 1 i I r r r r r I t r <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT <br /> y� <br /> DETAILS <br /> /pJ <br /> Client: Kns (.6lntrdL C/o /4K1 Msx� Sampler(s): ak►1 Rush Analysis: 5 Days _2 Days_24hrs_ <br /> V Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA1QC report required: yes_ no <br /> Address: 16 �S I� Time: Mileage: If yes,To: State Client _Other <br /> S-tV441A, 1k 17 SZ Lab number: <br /> Phone: 3 i K -6(13 <br /> s _ x <br /> FAX: E5m <br /> Ua g W o Z L4 y�•��'' <br /> a _ co <br /> Project name: Ph e4,4 v <br /> Contacterson: a e <br /> 11 0 ° <br /> z <br /> 0 <br /> zSAMPLE INFORMATION <br /> a W T7 $ T <br /> 3 x <br /> Sample Date imeLocation Description Sample ° zZo<Number SampleT <br /> 0115'0 <br /> x <br /> U <br /> Nihil i-s- 44(3' 144 7s•' <br /> CUSTODY <br /> Relinquished b Date 7 /Time 13 /oRecei d b Da 7 Time �( <br /> Relinquished b 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 />