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PREEISIOiV. ENV[RO-TECH . CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> m <br /> CLIENT DETAILS <br /> w <br /> Rush Analysis: 5 Days _2 Days_2r4hrs <br /> o_ _ <br /> Client: �� SQA Sampler(s): �— <br /> Subject to ourcharge <br /> Customer Number- (C) 44A/QC report required: yes no <br /> {� Comp Sampler Set Up Date:— Time: <br /> o� fi t��5 � e If yes,To: State Client Other <br /> Address: a Time: j�e� <br /> Lab number:_ 22`7 C•f <br /> T'�one: <br /> s <br /> v 3 cu <br /> `'—' `gym o o +�� <br /> FAX. w s 7- <br /> 5C C q <br /> Project name: <br /> FIn <br /> I E o ? .. <br /> H • <br /> If Contact person: L' � �Iav � �€ z s"�$ _� z � � a 04a <br /> 00 <br /> c�` <br /> �3 U v U <br /> vZ. <br /> �a`� 14 <br /> SAAWLE INF <br /> sample Date Time a < a �C <br /> Number Location Description Sample Sample 4. x g a " a U <br /> M614 t 941 O <br /> 4 <br /> m <br /> m <br /> N <br /> m <br /> v <br /> CD <br /> m <br /> m <br /> m <br /> m <br /> Relinquished by ,Date(Ull_'S � b Time ' Receive Date <br /> m <br /> Relinquished by: Date Time Received by: Date ime <br /> 7777 <br /> CS) Relinquiahed by; Date Time Reoaived by: Date Time <br /> Er..r p�rH ""°,N.W-�t Lane Si to B2 Stockton CA 95210 *Telephone(209)477-8105*FAX: (209)477-8148 <br />