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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> 7Sampler <br /> 1 1Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: // ��=5�� � (s): 1.4' ' �" I Z V <br /> Subject to surcharge <br /> Customer Number: <br /> QA/QC report rCe'qQui�red: yes noCom Sampler Set Up Date:— Time: <br /> Address' 4 7 ± / zeS f J? Time; Mileage: If yes,To: State Client Other <br /> _S7/Dch Lab number: o -O <br /> V <br /> .zone:— 2 04)) 4-66 72 5 <br /> FAX: �� 4 r V <br /> a <br /> s o z vj r o a x <br /> 1, � a d' <br /> Project name: r 'r �'� riS�C� Oi�� q <br /> AJContact perso uo` a o o Q w v <br /> z sus z <br /> INFORMATIONSAMPLE <br /> Sample Date Time d w rR a <br /> Number Location Description Sample Sample Z> es <br /> Z4 10.1001fr I P <br /> / .`onP y <br /> n 2 :t ' f; N <br /> CUSTODY <br /> { Relinquished by: Date Time Received by. Date S �T�ime <br /> Relinquished by: Date Time Received by: Date 1 Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 3935 N. Coronado.Ave_ * Stockton CA 95204*Telenhono(209)477-9105*FAX: (209)546-7497 <br />