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PRAOSION ENVIRGTECH <br /> CHAIN OF CUSTODY <br /> = m4C m <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING INFORMATION <br /> t <br /> Client 1� r`` Samplers) ash Analysis 5 Days _ 2 D s_24hrs� <br /> Subject to surcharge <br /> Customer Number Comp Sampler Set Up Date — Time QA/QC report required yes/",,— <br /> no <br /> Address - - .._ Time Mileage If yes, To State Client Other <br /> Lab number <br /> Phone boc)) �f n�L U <br /> FAX <br /> J [ q3 x <br /> Project name. H Q _ <br /> N �y <br /> Contact person a { E m w x u <br /> cF z mv � b � o <br /> � y z --• <br /> 9 a 3 3 - <br /> SAMPLE INFORMATION <br /> Sample Date Time <br /> Number Location Description Sample Sample z 3 /� <br /> pl � <br /> ,L 1 1�l W 4 ED <br /> I <br /> i <br /> 'A CUSTODY <br /> Relinquished by ' ateE '1 1 . Time �.� Received by Date � d 'Time <br /> Relinquished by Date Time Received by Date Tame <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 />