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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: �>��>�+ � M�2(�-I-1' Sampler(s): M I K-C (�%'1 <br /> Customer Number: Subject to surcharge <br /> JIJ\ QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: E' U 56-X Z(�d Time: Mileage: If yes,To: State _Client _Other <br /> �ATJi G� 95-241 Lab number: a.SZg�—� <br /> Phone: C2o'J ) 33Y ' �i3 <br /> FAX: (2,1:�`1) 334 -07Z3 E5 <br /> a y'm 0 ° z 6 F' ,e `a <br /> Project name: <br /> g gFo N H w d o z <br /> Z Q <br /> Contact person: �'� 1 CE -(Dy J <br /> z °oz 4 9 bi <br /> $ <br /> BSAMPLE INFORMATION <br /> Sample Date Time <br /> Q w <br /> Number Location Description Sample Sample F z'°> <br /> Relinquished Date ! '431'ime IZ' ys Received by: Dateime 12 K <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 />