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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Client: er(s): e +� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> L ��"G�.-1"��� Sampl �T�✓ � l DSS — <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: F��j'� —`� /�V— f1 Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> Time Milage: l o 9 Z I I — <br /> C Cc o L G�� `l 0 Lab number: <br /> Phone: 221 — ft4-7SAMPLE CONDITION <br /> Sample Temperature: Celsus <br /> FAX: PS—L .•(f <br /> c3 <br /> o o <br /> z <br /> v =d x t O Leaking. O Broken. O VOA Headspace <br /> � 1 mss= <br /> Project name: ` T�� '''� oft S G-9:2 3 F Q c 0 Custody Seal( )yes ( }no <br /> Q SFO G N m <br /> o u Z <br /> Contact person: �� ueyk. �/r (2P �� 2.2s <br /> o • <br /> o zz <br /> E F z m -o z S <br /> fA <br /> )Ice Chest OUPS (Wed Ex Drop off ( )Other <br /> SAMPLE INFORMATION <br /> m 4 z3 m c <br /> Sample Date Time d ,g¢ a° Q x z <br /> Number Location Description Sample Sample F z° a m 0 3 m a °0 • A <br /> 1 vto — fir^ C - 4` E PS} PA Y ' c tc�- `s 1 c_ <br /> ' OD <br /> Relinquished by: Date tJme I1 IS Receivedy: Date -- <br /> Relinquished by: Date Time Received by: 7 7 Date Time <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 />