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r�" ■ S r-1, r�l,, r-0,., r--@, «. r­zo] <br /> PR�: ,� CHAIN OF CUSTODY <br /> 510 N ENV 1 R� TEE H ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING O ' <br /> Client: t �t � Rush Analysis: 5 Days e Days_24hrs <br /> ror�_. QC BC1 Sampler(s): Vtcw �t . �. 1� o�_ <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date: Time: QA/QC report required: yes A` no <br /> Address:---@20 ! �1 . (,�7� � n Time: Mileage: If yes, To: State Client Other <br /> Lab number: -1 D <br /> Phone:. -- � � 5 <br /> FAX: Za x d <br /> P <br /> Project name: u S'4 <br /> z <br /> o <br /> Contact person:.9-��� }Tr <br /> z 3 z o tea} <br /> Now <br /> SAMPLE INFORMATION 0 w� a <br /> O 4N � <br /> Sample Date Time <br /> Number --..._Location Description - - <br /> Sample Sample z <br /> -D <br /> e - 9 <br /> 3— KA -.Lt74 (Lea 3W CO 3 x <br /> cs7 3 <br /> CUSTODY <br /> Relinquished by:V& Date Oiok ime I1 910 Received ate p. 'me <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, St. Suite A* Stockton CA 95204* Telephone(209)462-0892 *FAX: (209)462-7935 <br />