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PRECISION ENVIRD-TECH CHAIN OF CUSTODI� ` <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT 1 7Sampler <br /> 'ORINFORMATION <br /> Rush Analysis: 5 Days 2 Days_24hrs_ <br /> Client: <br /> r._ ` 1_- A____ <br /> �' �_ � �:... .� <br /> � Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date: Time: <br /> Address: Time: Mileage: <br /> If yes,To: State Client Other <br /> Lab number: <br /> Phone: <br /> ° 3 <br /> FAX: <br /> w scac z o m � <br /> 1 <br /> Project name: g a g �, H o Z <br /> 1 e w w t9 q z W J o <br /> Contact person: 01, <br /> a F z y z o c <br /> m A w W 4Q)ti <br /> o 333 U G m U? <br /> G U v <br /> ; ) CU <br /> SAMPLE INFORMATION co El m O <br /> Sample Date Time 3 o, x ro <br /> Number Location Description Sample Sample z'° a. m21 4: <br /> U <br /> A. <br /> V <br /> 4o, g <br /> CUSTODY <br /> Relinquished by:� - ;` - "�Date f Timet �l+' Received by: Date `�• Time <br /> Relinquished by: i 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 />