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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> I—CLIENT • . REPORT •R • <br /> Client: � Sampler(s): Rush Analysis: 5Days <br /> . ' _ il: a — 2 Days,_24hrs <br /> p <br /> Customer Number: Composite Sampler Setup: Subject to surcharge <br /> I <br /> q _-Date: Time: QA/QC report required: yea no <br /> 1 �� <br /> Address. S l O VI C�O S'''y 2¢ �- Subject to Surcharge Field Sampler: If yea, To: State_Client _ Other <br /> S o c C C . 015206 Time Milage: <br /> Lab number: _70 an I _04 <br /> one: 20 - 9u- <br /> FAX: <br /> 9 $ 2- • • • <br /> s" <br /> FAX: 2og - q 2 S - lJ 0 S p _ m�a Sample Temperature: Celsus <br /> a o <br /> z <br /> Leaking. ()Broken. ( )VOA Headspace <br /> Project name: S Custody Seal()yes ()no <br /> Contact person: O ✓vl '�� v o m • 1*LV • <br /> �aLIM <br /> 0 <br /> z S <br /> • • e 8 AA" a s e ()Ice Chest ()UPS ()Fed Ex ()Drop off ( )Other <br /> Sample ° a•- o m c7 o� <br /> Number Location Description Date Time `o `" 3 a $ x z • • , <br /> Sample Sample z a �, % a ;; OEM 1ADD <br /> 2 d P S _! <br /> � - S <br /> I - A1�9 I 12 3� h — <br /> I h - <br /> 5 a <br /> CUST <br /> OD <br /> Relinquished Date —71 Time''" ,_ Rceived by: - Date f, Time I '. <br /> Relinquished by: Date4�Time Received b Time <br /> 'Z' <br /> _ '' Y ate <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 />