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'PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS7Samplpr <br /> ' I ' INFORMATION <br /> I Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: �'m I's e-rl w t is pyo d v C,tS __ <br /> ' Comp site Sampler Setup: Subject to surcharge <br /> 5 bi P� <br /> Customer Number: Date: JV Time: QA/QC report required: yes no <br /> Addr J To s: Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> f o Time Milage: Lab number: <br /> Phone: �Z�' ��6 — C3 x � • <br /> v y M <br /> 9141 C1 r 0 <br /> q Sample Temperature: Celsus <br /> FAX. o= <br /> z <br /> ( )Leaking. ( )Broken. ( )VOA Headspace <br /> b <br /> Project name: `t r a Custody Seal()yes ()no <br /> Mo x m • • • Rr <br /> Contact person: {� 3 <br /> a q 333 m v <br /> a d ( )Ice Chest ( )UPS ( )Fed Ex kDrop off ( )Other <br /> SAMPLE' INFORMATION � Z <br /> Sample Date Time d a a zANALYSES <br /> Number Location Description Sample Sample z w REQUESTED <br /> (- ox Cho - SSW SbUc,,� ��-�► !/.�Ud C- p )V? <br /> 7CUSTODY <br /> Relinquished by: I if <br /> 777-7 1 Datei�^�I Time Received by: Date Time� S <br /> Relinquished by: Date Time Received by: 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:Petal545@sbcglobal.net*www.petallab.com <br />