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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQ UEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING / ' / <br /> Rush Analysis 5 Days _ 2 Days T24hrs <br /> Client i i`�1� � [�`[��.� Sampler(s) � �/Gt,/ <br /> Subject to surcharge <br /> Customer Number CSS <br /> Comp Sampler Set Up Date ._.._ Time QA/QC report required yes no <br /> Address Time Mileage If yes, To State Client Other <br /> Lab number� i 0 7 —0y <br /> Phone <br /> S x <br /> m <br /> FAX- <br /> 0 mx 3 x d <br /> V_ /) !P o a ro a ,� c <br /> Project name- N v <br /> Nil <br /> Contact person `� 4 �s d; V �, co <br /> �l of QK i ri a z y ° Ct] <br /> _ _ ` <br /> SAMPLE2. <br /> GQ <br /> INFORMATION <br /> cm� a p�c73 O Rte ' b <br /> Sample Date Time 6 a i m <br /> Location Description a o o <br /> Number Sample Sample z <br /> 3 - / 0'21131 J/�/7IW' 1V W <br /> nq &V — 2 122,0 >- <br /> X x <br /> • - iCUSTODY <br /> Relinquished by Datet-/r�T1me Received DaIJAADime 1 <br /> Relinquished by Date Time Received by Date Tune <br /> Relinquished by Date _Time Received by Date _.,_/a'me <br /> - <br /> O EC 45 vel t S * on 520 * lep on (209 462-0892 *FA) 209)4 2-7 <br />