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PRECISION ENVIRO=TECH CHAIN Or CUSTODY <br /> AND ANALYSIS ICER VEST DOCUMENT <br /> C 11 + 1 <br /> Client: J —_— _-_ sampler(s): �_. _ <br /> Rosh Analysis:5 Days _2 Days_24hrs <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:.. Time;_ t2 QC report requ red: <br /> -------- A/ yea" no <br /> Address: <br /> ----- Time: — Mileage; _— I if yep,,To; State�_..Client ` other <br /> Lab number: <br /> Phone:— � -lip I <br /> S n <br /> n} <br /> FAX: <br /> Project name: m <br /> Contact person: a Q m <br /> H3a 3 $ a <br /> Sample Date Time <br /> Number <br /> Location Description Sampla Sample <br /> t: 2 Z=Q W <br /> t <br /> res14 G.,.G o... 5V��,,, <br /> sos S. X101 d . - <br /> �l <br /> Relinquished by; Mnr Date-9/1&Ti - `-flr7 Received by: <br /> RaL+ngiriabad by;�__ Date —_='Time Received by: —� i_Date.— ,11me <br /> PREI:ISION ENVI IO-i CH 7743 N- West Fane,Suite B2 'Stockton CA 95210 `Telephone(209)477.8106"FAX:(209)477.8148 <br />