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CHAIN of cusTovY <br /> PRECISION ENVIRO-TECH <br /> ANDANALYSIS REQUEST DOCUME NT - <br /> CLIENT fW11AILS <br /> Client:�` P r' V• (�Q fi.�5� Sampler(s): <br /> ITT -7 <br /> ush"alyDays _21harge <br /> Days_24hrs_ <br /> �A Y�,O r1 <br /> Subject <br /> aur <br /> Customer Number: ' A report required: ye co <br /> t Comp Sampler Set Up Date:— Time: sr <br /> Address: a� �'�US�CY1 ` �� Time: Mileage: IF yes, To: State _Client! —Other <br /> n d PA �( (5 l( Lab number: <br /> Phone: L) 7 �Y7 z57 / U <br /> FAX: <br /> � t5 E <br /> Project name: �- P ��C)y Sf CYC c,.. 3 :aF N n a v <br /> Ga z <br /> Contact person: '✓� V - �1� 3 5 <br /> a <br /> w U. <br /> SAMPLE INFORMA <br /> a �qE� <br /> Sample Date Time < <br /> Number Location Description Sample Sample z°> ci <br /> Ll3'-(s �� I��� i . dire k n N 31 940 <br /> 5 14 DM R11 11 <br /> Relinquished by Date �� j�«�ixna tl eceived by: Datime <br /> Relinquished by: 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 />