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PRECISION ENVIR®--TECI I CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORT WFORKATION <br /> Client: IV Qn\ U. n J—QA S C" A tNVS SO C Sampler(s)' a y �^� a/ Rush Analysis: 5 Days _2 Days_24hrs <br /> ^Yr �y6c-zv.�.ar Subject to surcharge i - <br /> Customer Number: <br /> p II — Comp Sampler Set Up Date:—Time:_ Q,�@C report required: yes_ no <br /> Address: 90-2- , �s fpm Lti a 1 Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: <br /> Phone: <br /> to C, ZZ� s a - m -P I <br /> FAX: F a a <br /> o <br /> Project name: C\tip ncJn l O1 0 - 0/t=, :0 �j� 6c <br /> e a <br /> z �i L o 4 <br /> Contact person: C� VJA� 8 9 <br /> z r ' <br /> ( b <br /> v. 4 <br /> SAMPLE 1NFCPRMATf0N <br /> e g ° $ 3 q 3 r1i }�• U G v� •�7 <br /> w .� E 3 n c U <br /> ' <br /> Sample Data Time a' <br /> Location Descri tio P� <br /> Number pon Sample Sample <br /> OAM102010t405A- bob 1'33D <br /> A/&1'f VylW 7-0 10(a 017 P] <br /> f4wZ0(DC'0Tc- <br /> / <br /> i/o A vn t,J 7-010(a6 <br /> N�AvnwzOloc¢t�S� J( <br /> I <br /> p se <br /> 7t7 0 <br /> 14 D1kJ <br /> Relinquished by: Date Time�` Recei db , Date Time 1 <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)477-8148 <br />