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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> DETAILS <br /> . REPORT INFORMATION <br /> Client: A <br /> (s): Rush An 5 Days _2 Days_24hrs <br /> ��Q, c�q GT C,-(, V ti i�QY1�l�TQ I ander <br /> `� Subject to surcharge <br /> )` �� Composite Sampler Setup: <br /> Customer Number: 1� Date: Time: QA/QC report required: yes no <br /> Address: % 3--1- s\n<xw- Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> 'L� Time MLab number: <br /> ilage: . L4 0 S(3f 40 q - o f-1 � ( � <br /> Phone: 2 tl 6�h - 0(31Z M • • <br /> FAX: O� r _ 1 1 ` y m 3 _ x Sample Temperature: Celsus <br /> m a Q. m <br /> � a s". ` 0 z` <br /> Project name: OLeaking.OBroken.( )VOA Headspace <br /> NCustody Seal()yes ()no <br /> i o C9 8 F G '° <br /> Contact person: 1 5 L �- m; o m o <br /> g 3= ()Ice Chest ()UPS ()Fed Ex ()Dro off <br /> �ry p ()Other <br /> SAMPILE <br /> INFORMATION♦ • <br /> Sample Date Time <br /> Location Description o x <br /> Number p Sample Sample z a m w • IOLA 1 <br /> 11G0 F 1 i 090 GD GR ,l <br /> 2 4 TF _ <br /> L ' <br /> If <br /> Relinquished by S�Date �/Time� �/ieceived by: h Date 1�i Time�� <br /> il <br /> �/1�,,,. <br /> Relinquished by: ' Date ( 1$ime :41� received by: Date 1 r Time t r <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 />