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PRECISION ENVIROm TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT <br /> r Rush Analysis: 5 I]ays 2 Days 24hrs_ <br /> ��, �, , ti, _/�,,f . Sampler(s): v , � ..___ <br /> Client: s= <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> �! .� If yes, To: State Client Other <br /> Address: f _ i.. Mileage: <br /> Time: <br /> Lab number: <br /> Phone: <br /> FAX: s a ,� o o ] <br /> ti 5�y ° z o A � <br /> V o a X O <br /> Project name: f a ` " 5 <br /> a r v <br /> p 3 N w r~ o z <br /> • .� � o ,�F R � iE Z � <br /> K •• G. V =� T.. in � p <br /> Contact person: !!r %'r,�f% d 0 �; <br /> U a ? c P U <br /> z a R <br /> SAMPLE INFORMATION <br /> to Z: <br /> cc <br /> Sample Date Time a a a d o cc_a Q <br /> Number Location JDescription Sample Sample F z> <br /> �r <br /> 7777, CUSTODY <br /> Relinquished by: ~ � '' 7bate r Time '_'_1Receiv Dat �3 Time <br /> Relinquished by: Date Time_ Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Tiii,e <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2 * Stockton CA 95210 *Telephone(209)477-8105 FAX: (209)477-8148 <br />