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PRECISION ENVIRO-TECH CHAIN OF CUSTODY , <br /> AND ANALYSIS REQUEST DOCUMENT , <br /> CLIENT DETAILS .O . RMATION <br /> Client: pr1ir-- m I Q h F;' Sampler(s): � fi�� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Lt- �— Subject to surcharge <br /> Composite Sampler Setup: <br /> Customer Number: T <br /> Pate: Time: QA/QC report required: yes no <br /> Address: m Z' Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> r� r>� - Time Milage: <br /> \\ *` '-ah i4 �_L ). �w r Lab number: ©�©� q-01-014 <br /> V <br /> one:Zd�2 55� �/ x CONDITION <br /> FAX: Z© 1 �TC b S' C7 3 s ^ <br /> m m a x Sample Temperature: Celsus <br /> m w yAg z o <br /> e_3 0a 6 O Leaking. O Broken. ( )VOA Headspace <br /> Project name: g E5 h Custody Seal O yes O no <br /> a oB 9 <br /> • • • <br /> Contact person: 714ZA_�(/'i <br /> m .�A <br /> a <br /> 3 3 3 n Ice Chest ()UPS ( )Fed Ex )Drop off ( )Other <br /> SAMPILE INFORMATION t;s a <br /> Sample Date Time <br /> Location Descri tion Sample o ^ <br /> Number p Sample z> w m e m a A <br /> _ ) <br /> ki NO M CUSTODY <br /> / �� r( <br /> Relinquished hy: ^ Datime/ xJaa-Received by: Date ime �r1 <br /> Relinquished by: <br /> �Dat7�Time 2•�69'Yt z Received by: Dat4wiTime u <br /> Relinquished by: Date. Time Received by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />