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PRECISION ENVIR®-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Client: t�l t) Sampler(s): Rush Analysis: 5 Days 2 Days_24hrs <br /> �� <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: State Client Other <br /> Lab number: Sag 7-7-14 — C3 <br /> Phone: <br /> FAX: <br /> m x <br /> � o o <br /> ° <br /> C .� = z o <br /> a x o <br /> Project name: F A o <br /> E5 <br /> Contact person: v � <br /> CJ <br /> =9_4 <br /> 'Z <br /> , <br /> SAMPLE INFORMATION <br /> wco <br /> Sample Date Time d 0. N n`� <br /> p Location Description =0 3 3 x j <br /> Number P Sample Sample � z> w m 2 � w z ��� <br /> � U <br /> � CUST <br /> 11 <br /> 777 Relinquished by: D a t X—ALL Time Received by: DateU LljTime <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 />