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I 1 1 I 1 1 I <br /> PRECISION ENVIRO-TECH DANA S OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT ' 1 I ' INFORMATION <br /> /✓16 L 0• 4N,0EeSO AJ Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: � i 1y Sampler(S): <br /> Subject to surcharge <br /> Customer Number: QAIQC report required: yes_ no <br /> Comp Sampler Set Up Date:_— Time: <br /> Address: c2a klVUb7_b N C-N Time: Mileage:-- If yes, To: State —Client _Other <br /> 110DT CA 9S2 40 Lab number: 1401-01 <br /> Phone: laaJ� 3(07- 370 <br /> s - x <br /> FAX: 3 0I <br /> G C <br /> Project name- 2C174L� UIen�EQS� d �� a <br /> x Fo 2 <br /> g a zFa N W aW" y <br /> Contact person: 'b4m5 Waco o <br /> 39 a£a N z <br /> n <br /> SAMPLE <br /> I / <br /> Sam le Date Time a $ <br /> p Location Description Sem x �O <br /> Number ple Sample �' H a <br /> H CUSTODY <br /> Relinquished b Date Time-Received y: Dat 7 - e <br /> 7 <br /> Relinquished by: Date Time-_Received by: Date Time <br /> Relinquished by: Date _Time _Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, St. Suite A* Stockton CA 95204 *Telephone(209)462-0892*FAX: (209)462-7935 <br />