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f I f 1 i I 1 1 <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS1 <br /> REPORT + <br /> Client: 1�y Sampler(s): C I;"sb Analysis: 5 Days_2 Days <br /> _24hrs <br /> Customer Number: Subject to surcharge <br /> Comp Sampler Set Up Date:_ Time:_ @A/QC report required; yes no _ <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number. <br /> Phone: <br /> FAX.: <br /> Project name: <br /> a <br /> fie <br /> Contact person: d o�� <br /> c sa Z ¢'t �c Z <br /> Z .VJI a w Q <br /> SAMPLE '-_ as Cr4 Ua m <br /> Sample `1 s We g' <br /> cation Description Data Time w ; <br /> Number tiDti <br /> � Sample Semple <br /> x y <br /> L <br /> Relinquished by: Date V'L 5 nme!t�A_Receivedo <br /> Date_ Time <br /> Relinquished by: Date _Time Received by: <br /> Date. <br /> Relinquiebed by: Date _Time Received by: Time <br /> Date 9Yme <br /> PRECISION ENVIRO-TECH 7743 N. Wert.Lane,Suite B2� Stockton CA 95210*Telephone(209)477-8106 "FAX:(209)477-8148 <br />