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PRECISION ENVIRD-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS • i REPORTINFORMATION <br /> Client: �L �N M U"p�� Sampler(s): �� Rush Analysis: 5 Days _ 2 Days 24hrs <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:. Time: <br /> P <br /> Address: 0 . 3C�4 z 1 Time: Mileage:o� If yes,To: State Client Other CA I S Z41 Lab number: 03 2-Sg-`l5 C <br /> hone•_J���`�� <br /> S a x <br /> FAX: <br /> o <br /> Project name: PapEsTA ` A1'-,t- <br /> .4 Nil <br /> Contact person: U K z y z o r� <br /> W � <br /> J r U 9zJJ cl� <br /> SAMPLECz <br /> INFORMATION <br /> Sample Date I ime d 6 a x C5 -Z <br /> Number Location Description Sample Sample z a a a U <br /> rAv6451- C Q r-FICC- lr 5t�� J 230 GY- <br /> 7777 CUSTODY <br /> Relinquished by: DatejL?E!2�>Time Received by- Date Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> s <br /> PRECISION ENVIRO-TECH 774`3 N.West Lane,Suite B2* Stockton <br /> `r CA 952910 *Telephone(209)477-8105*FAX: (209)477-8}148 <br />