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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSISREQUEST DOCUMENT <br /> CLIENT <br /> n <br /> DETAILSPO KT INFORMATION <br /> /�� Rush Analysis: 5 Days _ 2 Days_ ors_ <br /> Client: .Qil l � ILv� � RTS o G Sampler(s): MIVJ�l..t Int c o <br /> Subject to surcharge <br /> Customer Number:_ <br /> l ' L� Comp Sampler Set Up Date:_ Time: QA/QC report required: yes_ no <br /> Address: �!B Z 1 v�c�S a Q, 1✓J��cv 1 Time: Mileage: If yes,To: State r—Client <br /> )_Other <br /> � 2.J/ Cf) 9� Z'`Ly / Lab number: ✓0! U OL/ <br /> Phone: 31p - 3 <br /> FAX: 3to`1 " ZZ a m= <br /> 3 o z <br /> o <br /> awl <br /> Project name: ( (A ✓kc,lu ul o She +n,-�k 1 F t 7s `5� �C a _ <br /> O ^ <br /> Ei <br /> Contact person: C", 2 V\30-a-Q, E_ o e I �� ? i <br /> xox Ul v u <br /> Sample Date Time v oa a° 's <br /> lumber Location Description p p F Z> g m� f� y p C <br /> sample Sam le co <br /> _ IJoAmv��}oloc�osP� jlbl��- ]l� zs -- <br /> a vnw lolD��sa y� u� <br /> oAmw+.►olo�osc yl(;zlo <br /> fl �twtlolDl�oS� �/� o�-I- <br /> aR ✓vmw vID1zo5t /te/od <br /> i <br /> Relinquished by Date 1 dgTime S`0_D Rec ' -'by: l <br /> Relinquished by: Date __Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, Suite A*Stockton CA 95204*Telephone(209)462-0592*FAX: (209)462-7935 <br /> 0 40 <br />