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I I I l I I <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT REPORT <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: 161- 0 A A/eePso U 3 ASSOC Sampler(s): <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: 2� Time: Mileage: If yes,To: State Client Other <br /> S2qy — Lab number: <br /> Phone: 101 s = x <br /> s � A <br /> FAX: El <br /> Project name: F E5 p a Q F o z <br /> z <br /> Contact person: DA Qg: F z z <br /> W o aba <br /> SAMPLE INFORMATION <br /> U <br /> Sample Date Time ° ¢ a 3 x c'), <br /> Sample <br /> Number Location Description Sample Sample F zo o y 3�?? a = 1,0a y U <br /> SI kWv VV W <br /> CUSTODY <br /> Relinquished by: Date I Time 10:I Z Received by: Dat � me <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, St. Suite A* Stockton CA 95204*Telephone(209)462-0892 * FAX:(209)462-7935 <br />