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�}ti�a�h�e�►'f' �- 1 <br /> PRECISION E NVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS <br /> 7Sampler <br /> ' 1 ' 1 'ff ( Rush Analysis: 5 Days _ 2 Days_24hrsClient: SuMA"d' W +rt Pr��jUL� L� <br /> AC�o posite Sampler Setup. Subject to surcharge <br /> Customer Number: ��' Date: /V X Time: QA/QC report required: yes no <br /> Address: )412- e31 Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> � <br /> Time Milage: Q�-0 �� � �VA C4 � �-�� Lab number: <br /> -Phone: ) ¢ �� - y�' - • 1 • <br /> U • ' <br /> � x <br /> l I <br /> aSample Temperature: Celsus <br /> FAX: L�_Ori) �'�r - Z��� m o x <br /> xv <br /> W <br /> 2= o O z <br /> Leaking. ( )Broken. ( )VOA Headspace <br /> Project name: P L OX 4 �" ` ° Custody Seal( )yes ( )no <br /> s Za A N <br /> C7 9 a n z <br /> SAMPLEContact person: Q y1�� O YI S C) ►/� t M • ON <br /> a 3 b a 0 Ice Chest OUTS ()Fed Ex ( )Drop off ( )Other <br /> SAMPLE INFORMATION 'F c w g m O <br /> Sample Date Time F > 3 ANALYSES <br /> ,Location Description zNumberSample Sample <br /> a c? ? w <br /> C>xv Ppu,ke r �`ro !vv r �a I l Ude & I P ��' h I- — - i -4- P tt <br /> 'J DIJ CUSTODY <br /> �{ <br /> Relinquished by: Date Time 1 1 `� Received by: Date Time <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 />