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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> 'UND ACLIENT DETAILS 1VALYSIS REQUEST DOCII;LIENT <br /> JJ�� //// ,(,/ 7RAna <br /> . , <br /> Client: ,/.�///o/✓ (uhf' MMMAnalysis: Days <br /> Sampler(s): y' _ 2 Days_24hrs <br /> Customer Number: � � �3/ � �G�� Subject to surcharge <br /> Comp Sampler Set Up Date:_ Time: port required: yes <br /> Address: �O . �O� -2/�D no <br /> Time: 14Lilea�e: if yes,To: State Client Other <br /> Lab number; — Qui <br /> Phone: <br /> FAX: S_5 D 7-:2Z <br /> A <br /> . / 0 4C O s 9 <br /> Project name: / ( 4 ��/ m q o f <br /> 4 <br /> ��/ J _Een Lti V m <br /> Contact person: <br /> o 0 o n7 <br /> o3 <br /> SAMPLE • W <br /> e ' n 3 � -� U.�a t/J <br /> RIVIIATION <br /> cation Description Date Time <br /> Numbery <br /> Sa- <br /> p a Sample E= 7 a ; 3 �, j <br /> s <br /> —607 r <br /> 7-is Y��� Date Time ereived bL11 vy:qy: DateGime � <br /> Date Time Received by: <br /> Date . <br /> Relinquished by: Date Time Received by: gime <br /> Date Time <br /> PRECISION ENVIRO-TEC.H 7743 N. Nest Lane,Suite B2 - Stockton CA 95210'#Telephone(209)477-8105 ' FAX(209),177-8148 <br />