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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND_WALYSIS REQUEST DOCUMENT <br /> CLIENT m <br /> DETAILS • REPORT ' <br /> W <br /> 0 97, <br /> '` l 1 <br /> CL Client:_T�QUl/7M Q u C (�`Q�, h W. Sampler(s): �Q.y t�S-�y Rush Analysis:5 Days_2 Days_24hrs_ <br /> F� 'f.�'16 Composite Sampler SEtup: Subject to surcharge <br /> Customer Number: AA Date: Time: QA/QC report required: yes— no <br /> Address: Cn 1 i 1 J f.y nV Q, Subject to Surcharge Field Seaopler: If yes,To: State (r Client_Mer + <br /> C 95310 Time Milage Lab number: b O 310 2.Z . Q l <br /> Phone: - `78 1% - <br /> LO <br /> FAX; 2 QQ �� _ q a ��� a Sample Temperature: Celsus <br /> U <br /> `o <br /> Leaking.C}Broken. ( )VOA Headspace <br /> ED Project name: S`L�'l�_y A <br /> s e 4 - Custody Seal()yes ()no eg <br /> Contactperson: 1.8 it SAMPLE TRANSPOWFATION.3 . U C I CI to vat r r g o <br /> ()Ire Cheat ();IPS (}Fed Es ( i1rop off ( )Other <br /> Sample s $ na S X11 <br /> me <br /> Numb" Location Description Sample Sample n'tZIORS 40-4 <br /> !!!AK 4'VP% 1. 21� 1 1-5A- C <br /> N <br /> m <br /> N <br /> t <br /> r <br /> m <br /> Lotl <br /> N <br /> m =WIS Relinquie�ed by: , _Date VV f Time?2 QOi41J.Rreiwd bFRelinquis-ed by: Date _TimeReceived by: Date Time <br /> mRelinquis-ed by: Date _Time R�_-eived by: Date Tame <br /> 3935 N. Coronado Ave. * Stockton CA 96204 * Telephone (209) 477.8105 * FAK (209) 543.7497 * Email: jhvle®petallab.eom * www.petallab.com <br />