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PRECISION ENVIRO-TECH CHAIN OF 'CUSTODY <br /> # AND ANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT , s „� REPORT <br /> P , ■ , ■ , <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 /> P. O 6q x 21 H VMileage: f If yes,To: State Client Other <br /> Address:__ _ Time: <br /> + <br /> I�l � � � ��1 r Lab number; <br /> Phone: 0-0i) Z <br /> � x Y <br /> FAX: cl <br /> Project name: � � 772Jc�iJG �A o ° 6 s fi <br /> Contact person: M 145 -My <br /> b�SAMPLE INFORMATION ^a <br /> m H � g � ti o � .-, �x 'ts <br /> Sample Date Time <br /> Number Location Description Sample Sample z° c U <br /> a(�OT 10 �lXl i <br /> s <br /> • CUSTODY <br /> � n L x <br /> Relinquished b Dat� ime!�eceived by: ,. Dat Time <br /> Relinquished by: Date Time Received by: Date 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 />