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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS A REPORTINFORMATION <br /> Rush Analysis: 5 Days 2 Days 4hrs <br /> Client:''J i t„i.r h) } V( ,p{i t'� _ Sampler(s): /����/<h ,T <br /> Subjec�surchargeu� <br /> Customer Number: _._ QA/QC report required: yes <br /> Comp Sampler Set Up Date:— Time: no <br /> Address: % ` n r�TG �'�+�=1 ^ C -� _ Time: Mileage: If yes, To: State Client Othe" <br /> / Lab number: 'U�'L' J z� ' <br /> Phone:l <br /> FAX: J <br /> Gl � a,.� <br /> r m <br /> Z <br /> V /► T a l� <br /> Project name: I� �� O <br /> 1�.j 1 = R z F Q 0 ,Ej <br /> v <br /> z W Z <br /> Contact person: <br /> SAMPLE INFORMATION, p _ <br /> Sample Date Time ;z -4 <br /> Number Location Description Sample Sample z a �_v 3 _ •\ s til J <br /> 1 e � 1. �o _n PG �� 3 X l <br /> 77777CUSTODY <br /> Relinquished b Dates Time f>G' Receiv i Dat / <br /> Relinquished by: _Date Time Received by: Date Titne <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 w FAX: (209)477-8148 <br />