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IPREC631 IN LNillRb. l ECh 1 CHAIN OF CUSTODY I i <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILSI <br /> ��// 1 1 1 <br /> Client: /YZt � 0. a,tkivro)n +- prfc-e . Sampler(s): clq� D Huth Analysis' 5 Days _2 Days_24hrs_ <br /> Subject te suharge <br /> Customer A'umber: <br /> rc <br /> � Comp Sampler'Set Up Date:_ Time:_ QA/QC report required: yeS no <br /> Address: ��2 1y4yS4A C Time mileage: If yes,To: State _Client _Other <br /> to d� ncr q 5-2.46s� <br /> Lab number: <br /> Phone: ?to7 '3 <br /> e <br /> FAX: 3(v r1 <br /> a awX <br /> Project name: r'qn1a✓d o Pr-op&,Lb1 <br /> j� 7 <br /> s o z <br /> Contact person: �I�v, /—Gt-LG o SAMPLE E =p <br /> ' <br /> z �S•� 'y Cj c v v,. <br /> Samp leDate Time <br /> Number Location Description <br /> Sample. Sample i> E 3 = <br /> > L <br /> l3l S, cl�T �12s/o ro.o p 6 r 3 <br /> d"A"-iic. v c.(!t <br /> ..S + CUSTODY Relinquished by Time`; <br /> 'c Reeeived by. Dat <br /> Relinquished by: Date __Time Received bp; Dafe Time <br /> Relinquished by; (' Date _Time Received bv: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, Suite A* Stockton CA 95204 *Telephone (209)402-0892 FAR;(209)482-7935 <br />