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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> C1,1F,N.r DETAILS 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: CompSampler Set U Date:— Time: <br /> l p P QA/QC report required: yes no <br /> Address' 4 �_l±'1/ zeS f• �� J? If yes,To: State Client Other <br /> ,L. Time; Mileage: C' /� <br /> •/ D v h V Lab number: �Q�o -O " 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 /> Contact 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 10.1001 fr 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 />