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erx"KISIGN ENVIRgeTECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> L IS=7_L�21 <br /> fRush Analysis: 5 Days _ 2 Days_24hrsClient: 1 t - - , 21,['.S; e <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Ti e: <br /> Address:_ ZG� If yes, To: State Client Other <br /> / Time: Mileage: <br /> �t3 �o �� �� D Lab number: ICSH i.' _.. �) <br /> Phone: 1— 112 S <br /> FAX: o <br /> ymti ° o L �x <br /> Project name: <br /> ci Ng A z w , �' off R <br /> Contact person: <br /> 49 z ;a <br /> cod <br /> SAMPLE INFORMATIONU, <br /> Sample T. Date Time v p¢ a y 7 <br /> umber Sample Sample z w <br /> Ix <br /> 4u <br /> ti <br /> J. <br /> .77Relinquished by: DateTime l� Received by: Dat e`z Time Q_ <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date_ Time <br /> PRECISION ENVIROJECH 7743 N. West Lane, Suite B2* Stockton CA 95210 *Telephone(209)477-8105 * FAX: (209)477-8148 <br />