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CHAIN OF CUSTODY <br /> PRE�lSION ENVIRH TECH { <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT ' <br /> MATION <br /> Rush Analysis 5 Days _2 Days__._24hrs <br /> Client G C� Sampler(s) y'G' �l <br /> / OU <br /> Subject to surcharge <br /> Customer Number _ <br /> Comp Sampler Set Up Date Time QA/QC report required yes no <br /> If yes, To State Client Other <br /> Address Time Mileage // <br /> Lab number 1= 0 1 I �� <br /> Phone x <br /> FAX <br /> A <br /> FAX u mx b 0 ~ <br /> Q� O O O <br /> s g z � <br /> e 0 <br /> Project name s p t 3 `� �r� -14 <br /> E �� <br /> Contact person a o o <br /> � CU <br /> 4 o aSAMPLE <br /> INFORMATION <br /> Sample Date Time a w ✓�> �R x } <br /> Location Description Sample Sample 0yNumber [j <br /> U �� 7111j 1 ),:" 1/0 6 f�� (/to <br /> 14 OW _ ' F CUSTODY <br /> Relinquished by Date Time Rece ed by a � ��Pime <br /> Relinquished by Date Time Received by Date Time <br /> I <br /> Relinquished by Date Time Received by Date Time <br /> PRECISION ENVIRO-TECH 545 E Cleveland, St Suite A* Stockton CA 95204*Telephone(209) 462-08921 FAX (209)462-7935 <br />