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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT / ' 1 <br /> Client: /A)n ✓`1C/��'1! Sampler(s): LD�/E Rush Analysis: 5 Day <br /> s 2 Days_24hrs <br /> Q Subject to surcharge <br /> Customer Number: [ZM <br /> /, Comp Sampler Set Up Date:_ Time: QA/QC report required: yes no <br /> Address::�h /0,P . �,/Ox o?I�!/ Time: Mileage: If yes,To: State(] Client _Other <br /> G(/U� G/r 9sayi Lab number: <br /> , <br /> Phone: <br /> FAX: (a09) 33`II — el7a3 emma - 3 <br /> Project name: f�UG�'l9al dFQ N v <br /> g �a z F' ti Z <br /> Contact person: <br /> Lou/� ,�idp� v _ = 6 <br /> m 9_ z ��s z ° W <br /> CG 'z <br /> SAMPLE <br /> Sample Location Description Date =1775 o a° 3 3 3 •�° z C <br /> Number P Sample Sample z> a <br /> ict'e haus <br /> INKULluf CUSTODY <br /> Relinquished by: Date -; Time �"/D Received by: Date. imegI 'I o M <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 />