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PRECISION -NVIRO-TECH CHAIN OF CUSTODY L <br /> ANDANALYSISREQUESTDOCUMENT <br /> CLIENT DETAILS A MOM <br /> REPORTINFORAUITON <br /> �— Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client:, I l/�U �/ �a T1 r`�� Sampler(s): A �C� L <br /> Subbjjeectttto surc rge <br /> Customer Number: Comp Sampler 7C' Set Up Date:— Time: <br /> QA/QC report required: yes no <br /> �n�u�T�G»L �R If yes,To: State —Client —Other Address: "70 Time: Mileage: <br /> Lab number: <br /> �f.4Gfd� C� g 57�4� <br /> Phone:/ Qq <br /> FAX: -Z`34- 271 � <br /> a s F m a s x <br /> g w a 5 z F y <br /> Project name: � <br /> UINrit' <br /> uJ N F a z <br /> Contact person: Agc� ` z s m o00 <br /> a � 333 m Vj c•t� p7 <br /> n �F a Yom ms O �•�x• 0 <br /> SAMPLE INFORMATION N p <br /> o <br /> m�3 � � �Q• 0 <br /> Sample Date Time g e <br /> Number Location Description Sample Sample Z> �� =' w ` '� U <br /> t m P=33 X <br /> --- <br /> CUSTODY <br /> �J q <br /> iG Gawr f,L7Ji Date GTime / <br /> Relinquished by: % Date Time Received <br /> Relinquished by: Date Time Received by —Date—Time <br /> Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane, Suite B2* Stockton CA 95210*Telephone(209)477-8105*FAX: (209)477-8148 <br />