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PREEI SI IN ENVI RI]mTEEH CHAIN OF CUSTODY <br /> AND ANALYSIS R).'Q UEST DOCUMENT <br /> CLIENT I)ETAILS EM'3owr INFORMATION <br /> Rush Analysis: 5 Days _2 Days_24hrs_ <br /> Client: !1.Lyr�j Sampler(s): OVI ('/657 a/ <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: 0 ' 1-3`� � Time: Mileage: If yes,To: State Client Other <br /> L. 0 0 C4, j Z¢ Lab number: I_ — <br /> Phone: 3 3 q—(oft z <br /> a m m <br /> FAX: 3�t - 0? Z j x A <br /> X14, <br /> h y <br /> Project name: U PP 1_ 5 A <br /> . •� � '� �F C � `Y z �W o�� `" <br /> Contact person: z v x aCIO <br /> OA a U• <br /> SAMPLE INFORMATION <br /> Sample Date Time a rR <br /> Number Location Description Sample Sample t8 us— �? a U <br /> WFA,,Xa weLA, e 6 yfY fw,' -fro *11 0,'y •� <br /> Relinquished by: Date �f�Time I/'' <br /> �77777Receive Data /Time <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 />