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PRECISION ENVIRD-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT m <br /> DETAILS <br /> "hAnalysia. <br /> Lo <br /> gull <br /> 5 Das _ 2 Days_24hrs mClient: M� ^tI�-£ Sampler(s): �� �Y y — m <br /> N <br /> (I�ILI.O►.� MP � Subject to surcharge <br /> Customer Number: Nm <br /> Comp Sampler Set Up Date:_ Time: QA/@c report required: yes no p <br /> Address: 25 71 Q /v 71"Y A40• °° <br /> Time: Mileage: if Yes.To: State Client Other <br /> Lab number: LD <br /> m <br /> p X68 - o3s/ <br /> A <br /> hone: <br /> FAX: Zn) 33Y - 07 aLn <br /> �p a, spa b o <br /> 4 X y 1 <br /> Project name; D40 D k-E s a a <br /> Contact person: o V `' a o a Z <br /> SAMPLE INFORMATION .4 <br /> � � � � '� o Qu yco <br /> � a`ai <br /> Sample Date Time 3< a ce 3a3 y t 1 R o� <br /> Number I�OCaItLOTi I)QSCTI��LOri Sample Samgle z'> a m�3 v_'i ; �Q`C <br /> U Nj <br /> 030 bt1 <br /> 2(131 N - 7'Uti y 4p a-ZI Z-Ju . <br /> z <br /> rriz <br /> C <br /> 1 <br /> 1 <br /> M <br /> — _ n <br /> X' y �f r Dr��d�Time 2: G) <br /> Relinquished b / Date Time Received b Dafe <br /> Relinquished by: Date Time Received by: <br /> m <br /> Date Time <br /> ` Relinquished by: Date TimeReceived by. m <br /> Date Time <br /> S PRECISION ENVIRO-TECH 545 E. Cleveland,Suite A*Stockton CA 95204*Telephone(209)462-0892* FAX:(209)462-7935 <br /> I <br />