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r I 1 I <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT 1 . REPORT INFORMATION <br /> ^I 7Rhysis: 5 Days _ 2 Days_L4hrs <br /> Client:_ �~ —' ampler(s): < �` r <br /> Subject to surcharge <br /> Customer Number: omp Sampler Set Up Date:— Time: port required: yes no <br /> Address: me: Mileage: State Client Other <br /> er: <br /> Phone: ---- <br /> �+ U <br /> G m ✓, <br /> FAX: L -12 a 3 0 A 3 <br /> i. <br /> Project name: y w ° <br /> Contact person: I �1 <br /> �- <br /> '� ` z m: z <br /> SAMPLE INFORMATION 0 0 <br /> Sample Date Time <br /> Location Descri tion <br /> Number p Sample Sample z/�> & c? m a ua y U <br /> }�JR IP S )C <br /> CUSTODY <br /> Relinquished by:y.;` F- - Date Z Time"S -U J Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date. Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane,Suite B2* Stockton CA 95210*Telephone(209)477-8105*FAX:(209)477-5148 <br />