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PRESSIDN ENVIR[]-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAIL9 SAMPLING <br /> / <br /> _ , , Rush Analysis 5 Days-42 Days_24hrsClient Sampler(s) Z <br /> C_ <br /> Subjectto surcharge <br /> Customer Number �—� <br /> Comp Sampler Set Up Date — Time QA/QC report required yes no <br /> Address ®5 A1. ( I>U ,_ W'4 If yes, To State Client�_LOther <br /> - .--.-- Time Mileage rr <br /> Lab numbers <br /> Phone C C-\ <br /> S x <br /> n <br /> � q m <br /> FAX �� �� ` 1 �l_. m;3 _ x <br /> w s m G7 <br /> Project name - <br /> r R LFA o o G <br /> Ul <br /> t -3 <br /> ! o to <br /> Contact person C ' �. 1 C/— v; o m o <br /> H z yd z o <br /> ? <br /> z <br /> SAMPLE INFORMATIONC7 "> m <br /> Sample Date Time d " a x'"333 Ena a o <br /> Location aeatloll Description Sample Sample F z a 3 a ri yi U <br /> VW VO fel" rIru,i1orN \-VkI A3r�i N )�z`►lii / �_� �, } (� <br /> Aid_ <br /> r4a4 <br /> � CUST <br /> i <br /> ! 1 <br /> .s' 1 <br /> Relinquished by �— .,���- Date �rI r I Time Z '' �' Received by ,�� *�' � � � Date ITl777 me <br /> Relinquished by Date Time Received by Date Time <br /> Relinquished by Date Time Received by Date Time <br /> PRECISION ENVIRO-TECH 545 E Cleveland, St Suite A* Stockton CA 95204 * Telephone(209)462-0892* FAX (249)462-7935 <br />