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PRICISION ENVIRD-TECH • CHAIN OF CUSTODY • <br /> AND ANALYSIS REQUEST DOCUMENT <br /> Rush Analysis: 5 Days _2 Days_24hrs_.. <br /> Client: IJ,C.1 D, i"1^. - Pr-s SO c. . Sampler(s): �^�/� <br /> mmmm" <br /> 6 �n Subject to surcharge <br /> Customer Number: QA/QC report required: yes_ no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: q i Z I d o �C W" Tjme; Mileage: If yes,To: State_Client —Other <br /> WG C 1'Z Lab numb So I ZsQ 9 – O Z <br /> Phone: 3t9-? <br /> 3 <br /> FAX: o A 3� <br /> �( m o <br /> y w ' <br /> GO <br /> � C4� <br /> Project name: C. lA t0 C -, � o` <br /> v a <br /> Contact person: C `'i^PCO <br /> a ^m x W o nu al <br /> SAMPLE INFORMAT10N <br /> Sample Date Time m '5< w' <br /> Number Location Description Sample Sample �' z'i 6 �'[. °' w" * '� U <br /> rrapMw3alZ5a�pr 12s1aS 9 3a <br /> /va n t1�u13o1 zSas� / f <br /> t <br /> I <br /> Relinquished by:—,. Date1=&me 1Z o S Receive Date z�13Time <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 />