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PRECISION ENVIRO-TTECH CHAIN OF CUSTODY <br /> r <br /> AND ANALYSIS REQUEST DOCUMENT <br /> ' CLIENT DETAILS REPORT <br /> J <br /> 3 <br /> t <br /> Rush Analysis: 5 Days _2 Days_24hrs <br /> Client.: �_>LA-1 07• f'M�.ln�Y��- ra _ Sampler(s): P�0�r'<_-0 <br /> Subject to surcharge <br /> Customer Number: <br /> Camp Sampler Set Up Date:. Time: QA/QC report required: yes no <br /> Address: '107— l okv54-,�of Time: Mileage: If yes, To: State Client f Other <br /> { p� AJ Lah number. /7I,52)1 <br /> Phone: 3(e q - 371� { <br /> FAQ: <br /> W (L ^' <br /> Project name:_ V�i vryn <br /> J Contact person: ab60GG o <br /> z <br /> SAMPLE o _ •1 C+ H � � _ �. O <br /> Sample Location Description Date Time <br /> Number Sample Sample z <br /> _310-5 HJ . TVrvLF�,r �,I�F�o IZ'. 3D <br /> a <br /> r <br /> i <br /> r Z k IL AlCUSTODY _ <br /> 77 <br /> 7Relinquished by: Date Time 1Z: Received _ Date r� Time <br /> Relinquished by:' ' Dale 7/ teReceived h ate <br /> i <br /> Relinquished by. Date _._Time Received by: DatN Tiwe <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, Suite A Stockton CA 95204"-Telephone(209)462-0892 FAX: (209)462-7935 <br />