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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS <br /> Client: Olt-1-6 N .GtUtio/f Sampler(s): —f bJ Rush Analysis: 5 Days _2 Days_24hrs_ <br /> 4Vl <br /> Subject to surcharge <br /> Customer Number: b M (� QA/QC report required: yes no <br /> nn Comp Sampler Set Up Date:— Time: <br /> Address: 'J x 2I - If yes,To: State _Client _Other <br /> ` Time: Mileage: Lab number: rt (12C� <br /> �✓�, C4 Z Y/ I - Q <br /> Phone: <br /> FAX: (2cri) 33F- o� z3 m9m s A <br /> Project name: d 2 <br /> 5 a 3w3 � l3 Q' F o -• <br /> o FFG v y + <br /> 4 11 Z W O M 1"1 <br /> Contact person: / L 7D� g o o <br /> w <br /> Z z <br /> SAMPLE INFORMATION <br /> sp'n <br /> Sample Date Time ¢ a m c+ m z <br /> Location Description 0 33 �y o w <br /> Number p Sample Sample Z> <br /> e lVyOy -r1 46 9zc � �� V P DW X <br /> 14 D10 F.]Iti MIM CUSTODY q �� 4;1-1 lB" <br /> Relinquished by7 Date /-a' Time Z'l �Q Recei y: Dat � Time <br /> 0"7 <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 3935 N. Coronado Ave. * Stockton CA 95204* Telephone(209)477-8105 *FAX: (209)546-7497 <br />