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PRECISION NVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> LIENTDEtAimg'� SAMPLING, <br /> r / ' r <br /> } Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: Time: Mileage: <br /> If yes,To: State Client Other <br /> rr11 <br /> Lab number: <br /> Phone: <br /> S x <br /> N <br /> FAX: 13W <br /> a gw z o +� <br /> l / a 0 ' N V °� <br /> Project name: testi t ,� v„ ( Slr� ctll� F A z <br /> a oFA A N z <br /> W <br /> Contact person: J, r aS v.�z a F o d b ° o <br /> z 3 z a <br /> o d tt 11 <br /> 41 <br /> Sample Date Time <br /> P <br /> Location Descriptio le Sample z=> 33 w U <br /> Number Sam m P 1 P P// a (�'`? �' <br /> 77 oD <br /> Relinquished b Date I( Time 10�17 V Received by: a Date2�`�LSTime ©- <br /> I <br /> Relinquished ky:_ Date Time Received b::_. Date.Time <br /> 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)477-8148 <br /> i <br />