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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT 1 I t` REPORT 1 ' 1 <br /> Client: N Q,I 10. ��Il l ( Y�V 1 ? (Ir cda 1 C Sampler(s): C �a 1( Q Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time:_ @M@C report required: yes_ no <br /> Address: Time: Mileage: <br /> q��n �LL I �I If yes,To: State Client —Other <br /> I� CA 15, 24 1 L Lab number: 5C 1 CG C TN " 0 <br /> Phone: <br /> FAX: 20 - 3(o92 Z 4 4�3 'a o ;qq �iq� <br /> H w G z 6 N vxm f <br /> Project name: M'21 IT d <br /> + A <br /> Contact person: R b"Cp H,;,Adf <br /> � m <br /> SAMPLEINFORMATION d �� <br /> Sample Date Time -7 <br /> Location <br /> Description <br /> Number Sample Sample <br /> pit , -c <br /> 1 ra d 5 a q:Z� P . I P — _3 - I Ix x <br /> Cat I lnQ- ( J-e.,t I <br /> CUSTODY <br /> ' / / <br /> Relinquished by: a Date �n TimeReceived by: Date+ .4,iTime aC <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 />