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I r r - f ' r r r - r , r r r r r r i r r r r <br /> PRECISION EINVIRD-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT 7Sampler <br /> ' 'f `+ 1 Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: _.. ): <br /> t Subject to surcharge <br /> Customer Number: <br /> �"--�� - ��� Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: Time: Mileage: if yes, To: State Client Other <br /> Lab number: <br /> Phone: = 'v - E <br /> S 3 m <br /> FAX: x y F CPQ <br /> s m o z o t� m <br /> C5 a `oda b m <br /> � N <br /> Project name: <br /> N E5 <br /> o <br /> Contact person: " <br /> pq <br /> Ca <br /> z U. � <br /> -SAMPLE INFORMATION <br /> Sample Date Time �¢ w �33 x [_ ; <br /> Number LOCat10I1 DeSC2'1pt10Il Sample Sample z o w 3 4 GoU <br /> fi <br /> 777 Relinquished by:l 4. Datel Time) " Received by: ` %�-`' S* Date Time <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 />