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PRECIS'®N ENV1R®—TECH • CHAIN OF CUSTODY • <br /> AND ANALYSIS REQUEST DOCUMENT <br /> 1 / / 7CompSampler <br /> / ' jW" / ' / <br /> � Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: as j D, PMr&it s(vt fess a c , u^^ <br /> G�t� Subject to surcharge <br /> Customer Number: QA/QC report required: yes— no <br /> Set Up Date:— Time: <br /> Address: ��� �� �'"4 AJO"} Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: 50I2509 — 01 <br /> Phone: <br /> FAX: ��l0 4Z2- <br /> Project <br /> Z-2 Project name: <br /> Contact person: s I z o dd <br /> yl <br /> INFORMATION <br /> H a s r o u ba <br /> as qa o ! <br /> Sample Date Time ' a & m m IL` p� c < 4 <br /> ;Number Location Description Sample Sample 'o�j U <br /> rloAnnwlo,Zsas,� /zsas 9;6D X <br /> g <br /> C. , <br /> 1A MAKI IN M� <br /> Relinquished by: Date(' Time ZI 6_> Receiv by. Date1_'AS6Time 'Z_0 <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRA-TECH 7743 N.West Lane, Suite B2* Stockton CA 95210*Telephone(209)477-8105*FAX:(209)477-8148 <br />