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PRECISION ENVIRO-TECH CHAIN OF CUSTODY � <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT / ' 1 <br /> 1 ,tom jam 7 Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: � � Sampler(s): ( C� l� <br /> Subject to surcharge <br /> Customer Number: !' J(34: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: Time: Mileage: <br /> (4(40LD �/( ��f If yes,To: State Client Other <br /> --' Lab number: SOS 2-513—V <br /> Phone: <br /> y <br /> FAX: <br /> m <br /> A o o W <br /> p w 0W <br /> Project name: ��'�� h Q <br /> Contact person: IL)"-'t S <br /> U d " <br /> m <br /> _ � V <br /> m m.H E" r <br /> 1 <br /> SAMPLE INFORM.—ATION <br /> y = 3 o t J!.-T a AWN x p <br /> Sample ate Time a e¢ w 3 3 m x ,� \J z <br /> Nu ber Location Description Sa le Sample h z'° w m c?3 <br /> 'k 4 CUSTODY <br /> 7777 Relinquished bto Time Z.Zl� Recei by: Date` :2K Time 42— <br /> Relinquished by: Date Time Received by: Date.Time <br /> 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 />