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i = = = = =4 <br /> CHAIN OF CUSTODY <br /> PREA5ION ENVIR17-TECH AND ANALYSIS REQ UESTDOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> r r Rush Analysis 5 Days _ 2 Days____24hrs <br /> -� <br /> Client r A 0� _ Sampler(s) ( C.-'-ca S3 Ir S <br /> O� ^ Subject to surcharge <br /> Customer NumberQA/QC report required yes no <br /> Comp Sampler Set Up Dae — Time <br /> Address a� © Time Mileage If yes,To State Client nrOtther <br /> t\ Lab number <br /> — �� 4 <br /> Phone <br /> s <br /> FAX r x <br /> o > op4 <br /> Project name. J9A Q - 3 o <br /> l , <br /> Contact person C S <br /> d o v v M <br /> Ci z W S b Z Q W <br /> z 3 3 g `� CQ ° '- <br /> ca 6d a 9 uUe, 9:3m > a m fy <br /> SAMPLE aINFORMATION E R <br /> aCn <br /> 'Sample Date xme � <br /> Number Location Description Sample Sample P z a a Q 45 U <br /> S r G, C-,,(bD 3 h <br /> C cw 3 k <br /> i <br /> CUST <br /> OD <br /> Relinquished by ate �, �ime Received by 17) Date 11" <br /> Relinquished by Date Tlme 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 />