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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS A REPORT UqFORAUTION <br /> 9 Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: y T FR6 7C/S Alwe 7Sampler ): �'�n Iv�/h l2'�,– <br /> Subject to surcharge <br /> Customer Number: S �� <br /> Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: 5700 V- 1T11Vy C / �� z Time: Mileage: If yes,To: State 'C`lilient Other <br /> tclG fL �� G g j 2/'7✓ Lab number: / <br /> Phone: ZA N— q3 — q64J(11 <br /> Gym <br /> x = A <br /> FAX: °° x <br /> N o GO V a x <br /> Project name: " A °' <br /> Contact person: m M w <br /> AF z =Q� z o <br /> z 3e9 a U� c° <br /> SAMPLE • ' • of A � � a <br /> Sample Daae Time d ¢ a° 3 m x <br /> Number Location Description Sample Sample z o a Ea 0 3 m <br /> 7777 � � <br /> Relinquished ate' me-51 b to e <br /> Relinquished by: ate Time Received by: ate . 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 />