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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT 1 ' 1 <br /> Client: NE,i. I 0AnderwyO A bsr L. Sampler(a): Ffnkl I Has Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Subject to surcharge <br /> Customer Number: <br /> qq _ / 1 , Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: 0O ? : ✓ }la ri a i Wa� Time: Mileage: If yes, To: State _Client —Other _ <br /> Lod 1 CA 5240 Lab number: 1 IO D <br /> Phone: , (a-1 - 3-701 <br /> :(:))tog -z}�8 3 _ " <br /> FAX: <br /> ci i .s m'3 o z 50m x <br /> 104-S <br /> O N l <br /> Q <br /> Project name: Inl�rh/ <br /> 5ktiUz <br /> a a <br /> Contact person: s` <br /> G� bj <br /> SAMPLEINFORMATIONw of e <br /> 4 O <br /> Sample Date TimeQ a "03 d z `�� � <br /> Location Description <br /> Number Sample Sample z> a" <br /> W C��It (I/�a/ l;bo C w <br /> (AA 11nil <br /> 1+ <br /> CUSTODY <br /> Relinquished by: Date 11 ime 3! Racal v by: Date,�fV Time `3' •" <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENTO-TECH 545 E. Cleveland,Suite A*Stockton CA 95204*Telephone(209)462-0892*FAX:(209)462-7935 <br /> J J I_7 -__-/ � ,J _J __J ,__J _J __a ,J -_.i _J .J ._-_1 J - A J <br />