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PRECISKIN ENVIRU-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> 1 t ' 1 1 1 <br /> Client: i -I i Yom) /J�1-�L 1�'�I__ Sampler(s): M I Rush Analysis: 6 Days _ 2 Days_24hre <br /> (� q Subject to surcharge <br /> Uustonter Number:_____ <br /> �–'._ --- Comp Sampler Set Up Date:— Time: QA/QC report required: yce_ no <br /> Address: ? �' c'���-�'� 1��` Time: Mileage: If yes,To:State _Client _Other <br /> Lab number: Z.V <br /> Phone: !'• <br /> '� ��1,> <br /> � ' ' <br /> FAX: C '"i ? 7 1 17 3 6 o; <br /> ae a y m Z q <br /> r �•. r/L�zni s - �F F o <br /> Project name: I'" „ c <br /> Contact person:. z <br /> h � o m „ a, <br /> a ,gE3 E 4Tx o <br /> Sample Date Time ' < , y 6 Q y <br /> Number Location Description Sample Sample ZR $a ! c mN: <br /> !A03 Jz:2o Or bd" <br /> Relinquished by Date I '43rime 17' yS Received by: Date7Vrimei2'y <br /> Relinquished by: Date _Time Received by: Data Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO•TECII 7743 N. West Lane,Suite B2*Stockton CA 95210*Telephone(209)477-8105*FAX:(209)477-8148 <br /> 1 1 1 I 1 I 1 1 1 1 I 1 1 1 J J 1 J _ J ' <br />