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F_- r r r- r. �- <br /> PRECISION ENVIRO—TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> /� ��j�� 7ys _2 Days_24hrs_ <br /> Client: 4g1 ��-�y&r.�t-Msey) AsSoC Sampler(s): ' ��r_r. <br /> to surcharge <br /> Customer Number: ed:Comp Sampler Set UpDate:_ Time: p q yes no <br /> ICL ly�arJs<,�-1wQ �'L�Cw- If yes,To: State —Client —Other <br /> Address: Time: Mileage: <br /> Lab number: <br /> Phone: 5-�-bf e <br /> FAX: <br /> Project name: Si' r 1'Cl_yiz ,PdtY i..�'-- ° 3�-� `� F^b Z <br /> w3 <br /> o Uv' mJ �c F Q .]' N m <br /> r✓1b4_ K <br /> Contact person: �'1 u.r_ o d eM m y <br /> X spy '_ z Z ? m N <br /> ° 8 d z .33 m = tj ^°a 01) <br /> SAMPLE INFORMATION <br /> Sam leDate Time <br /> Number Location Description Sample Sample <br /> k/ate} 17'.3u <br /> 2L� <br /> CUSTODY <br /> Relinquished by: ' .__ Date t° Time/" 45 Received Dates 204 'me <br /> 77 <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, Suite A* Stockton CA 95204*Telephone(209)462-0892,* FAX:(209)462-7935 <br />