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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS &Y.101• F 101 REPORT INFORMATION <br /> I ,- Rush Analysis: 5 Days A 2 Days_24hrs <br /> Client: b� ton4 /I'1;irpV..� Sampler(s): _Ti..bi rIG 1'1/y.l <br /> Subject to surcharge <br /> Customer Number: D M QA/QC report required: yes no <br /> Q650/,- 2'190 <br /> Comp Sampler Set Up Date:�"�+.Time: 2Ha <br /> Address: 199320 W. C +He_ftAA Ln. 5 E Time: Mileage: If yes,To: State _Client _Other <br /> 1 <br /> L1i Lk 952--I1 - Zifda Lab number: (pod,100 k — 0 \ <br /> Phone: (ZOO 33N - !olvt3 <br /> s = <br /> (u�� 3 s a <br /> FAX: 33H - 023 <br /> w o <br /> ° 00 9 aG <br /> Project name: 1;01 + GUS n 3 v FA j v <br /> O N <br /> e V SFn Z <br /> Contact person: c� zSAMPLE <br /> INFORMATION CI U G'c vl <br /> mm A <br /> Sample Date Time g o. �, z 6 ¢' m <br /> Location Description o 33 i ro o <br /> Number t GG p .S1ample Ssample z> a �,ci �, a m`7 U <br /> GILL NJ I <br /> 114 D10 Va'l ti. CUSTODY <br /> Relinquished by: Date�/0�°4 Time `'OZ Received by: IJ�y Date2-10-"Time q..GzAtl <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 Y Stockton CA 95210 M Telephone(209)477-8105 FAX: (209)477-8148 <br />