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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS <br /> REPORT INFORMATION <br /> MMMM7 <br /> Client: ODI V^n"'t Lj"'-ft/ 4t)9.Te__,—S 7Spler(s): D1 VW Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> (Mt) q3 ! —;7,10 Composite Sampler Setup: Subject to surcharge <br /> Customer Number: 1 7 Date: <br /> (� ,� p D � Time: QA/QC report required: yes no <br /> Address: 1200 L)&AQ(' Ml Subject to Surcharge Field Sampler: If yes, To: State ( Client Other <br /> Time Milage: Lab number: Z <br /> Phone: CO <br /> > _ x <br /> FAX: 4 mat x NDITION <br /> Sample Temperature: C Celsus <br /> • � s ° s <br /> o ?m c z <br /> d ° a Leaking. O Broken. ( )VOA Headspace <br /> Project name: `�` b� e 13 a Custody Seal O yes O no <br /> � R rra A N • <br /> SAMPLE TRANSPORTATION <br /> Contact person: <br /> H Q �� z <br /> a' ` I - ( )Ice Chest ( )UPS OWed Ex ( rop off t )Other <br /> SAMPLE INFORMATION Cr -0 t: <br /> R � v <br /> Sample Date Time a a "� a z <br /> Number Sample Sample <br /> Location Description =o -F' r: � ���� �� n. � ANALYSES REQUESTED <br /> �L ' l s y f�,. _--- Date i�_� Time`W-N 2(r <br /> ___`�7__7 <br /> Relinquished by: _.^ Uat ime_ Received b _^ <br /> Relinquished by:___�— —_-Date i ime_.�_—Received by:--,—. ,_—Date____.._Time <br /> Relinquished by: Date Time Received by: _Date—___ -rime <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477 8 05 * FAX: (209) 546-7497 * Email: jhvle@petallab.coin * wwwl Page 2 of 7 <br />