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PRECISION ENVIRO-TECH CHAIN OF CUSTODY C 4- s <br /> ANDANALYSIS REQUEST DOCUMENT <br /> SAMPLINGCLIENT DETAILS ' 1 ' INFORMATION <br /> ]� ( Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: 5u M I se 4 LV;re (D J C C) ut1�� Sampler(s)___ �l 1 <br /> Composite Sampler Setup: <br /> Subject to surcharge <br /> Customer Number: Date: '1 Time: QA/QC report required: yes no <br /> Address: /112- P Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> S Co <br /> ,5 )-0,5-- <br /> Time Milage: Lab number: O O D O q — Q1 <br /> Phone: �ZC�`� 4 (�� �j ? x • MEN • <br /> ^y M <br /> \ Z 51 c7 s <br /> FAX_ �Zo cj l CI ( - Sample Temperature: Celsus <br /> m�3 x a <br /> i9 .w= � o 0 <br /> ° sem. z <br /> S a o; ° O Leaking. O Broken. ( )VOA Headspace <br /> Project name: a y ( >Y ( > <br /> Custody Seal es no <br /> F A t0 <br /> SAMPLE • • <br /> Contact person: I d o m <br /> 6n °E" z 3' ; z O <br /> 3A z 3 b ( )Ice Chest ( )UPS ( )Fed Ex XDrop off ( )Other <br /> INFORMATIONSAMPLE <br /> 5 3 <br /> Sample Date Time ° w <br /> Number Location Description Sample Sample z> w w � ANALYSES • 1 <br /> c_1_o Sq u S w--' 4+1( Iuac& P NP - 5w - - - ( - <br /> CUSTODY <br /> Relinquished by: �" Date Time Received by: Date It �ime -1I <br /> 777 <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 />