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1 � 1 1 1 1 1 1 1 1 1 <br /> PM�US10N ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQ VEST DOCUMENT <br /> CLIENT DETAILS RBP0R'l' lNF0I?Aljk'l'J0N <br /> Client: Dlt'L'Orj Mu2.FPrK Rush Analysis; 5 Da <br /> Ys ya _2 Daye_24hrs <br /> Customer Number: � <br /> Subjecttosurcharge <br /> Comp Sampler Set Up Date:_ Time:_ Q/+/QC report required: yes_ no _ <br /> Address: j O B��( Z� &J Time: Mileage: If yes,To: State _Client _ptber _ <br /> �a f fL Lab number: .SD.P/IID1 <br /> Phone: <br /> FAX: bol ) -334 - 0 -7Z- 3 �e A <br /> Ce <br /> / O C so 96 O <br /> Project name: <br /> s as s he <br /> Contact person: t 5B r ; m is yyZ <br /> FSAMPLE INFORMATION <br /> qq <br /> Si a t^, = ��° S <br /> Sample <br /> Number Location Description DSamatpe T e <br /> le Semple — z <br /> 000 E• r <br /> tl <br /> Relinquished by: Date <br /> Time Received by Da p 11 ST�e el �, <br /> Relinquished by: Date _Time Received by-. <br /> Date Time <br /> Relinquished by: Date _Time Received by: <br /> Date Time <br /> PRECISION ENVIRO•TECH 7743 N.West Lane,Suite B2*Stockton CA 95210*Telephone(209)477-8106*FAK(209)4778148 <br />