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1 <br /> L c� <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY 6 0,;z--o <br /> AND ANALYSIS REQUEST DOCL HENT <br /> CLIENT DETAILS I REPORT INFORMATION9 <br /> A MMM <br /> Er M <br /> I Rush Analysis: 5 Days —2 Days24hrs <br /> 1 Client: All� C�• A'�I��C� � F�C�OC • San�pler{s): — <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sainpler Set Up Date:_ Time: QA/QC report required: yes no <br /> Address: �AA kh)UL-;-6N Tirue: Mile if yes, To: State Client Other <br /> ZAOT A Lab number: tic I -! f .O - O <br />:J <br />— Phone: <br /> r � x <br /> Z . .r �rrYi; - ----- .. _ _. .. _-- -. --. --:.:'-Y'-� is 1 �+: - r _- -i-mr- -r_- -Ii-r "-I "-r - .r- ...�_..-- J- ._ T`-.-r r. :'t--...r. ...�-- r T- -1-�—r"--r- I—..... <br /> Z <br /> aY o <br /> Project name:—_lti'h1 1,J <br /> 3m3 <br /> J c? z e'e J Z <br /> i <br /> Contact person:_ C � <br /> s� m <br /> SAMPLE INFORMATION <br /> C.�'D <br /> Sample Date Timea z, a mo 3 u2 " <br /> aLocation Description <br /> sample Sample '5 u2 <br /> x w <br /> r� <br /> o� <br /> N <br /> i.D <br /> V <br /> Di <br /> m <br /> N <br /> V <br /> 111 <br /> r-1 <br /> m <br /> N ' <br /> 9 <br /> 7Relinquished b <br /> ateme P'LZ Received by: Da � me <br /> Y- a Ti <br />[�v <br /> Relinquished by: Date Time Received by: Date Time <br /> m Relinquished by: Date Time Received by. Data Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland,St. Suite A*Stockton CA 95204 * Telephone(209)462-0892 FAX: (209)462-7935 <br />