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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> SAMPLINGCLIENT DETAILS • 1RT INFORMATIO <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:_ Time: <br /> Address: o 1f3X Z110 Time: Mileage: If yes,To: State Client _Other <br /> Lab number: (o I IU 0 1 'G I <br /> Phone: Zoe - 3'"1- 613 <br /> ) � � � � 0723 � �Yv M <br /> FAX: Zb� _ 3 _ P <br /> m x <br /> � A� 0 0 w <br /> F� <br /> �+ 'fl CJ <br /> Project name: �eZ2 i R �L 3 F Q F r <br /> z <br /> ll a o Fg <br /> Contact person: fel 0 A[ L- (10neRLtr:(� <br /> o 0 � <br /> ° ~N <br /> ct! <br /> c a 333 (� o a cc <br /> ° o z ``J,��y X C U <br /> a �� � �ci3 - �>, rn x �a� <br /> SAMPLE INFORMATION OP <br /> Sample Date Time g 6 0. 3 m x <br /> p Location Description Sample '° 3 3 3 Z a <br /> Number p e Sample z> w �? a U <br /> C <br /> LAW^ <br /> l� <br /> 777 <br /> CUSTODY <br /> Relinquished by: 4yi `tel/' Date LL-34 TimeReceived by: Dat Time 10 , 55 <br /> Relinquished by: Date Time Received by: Date r 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 />