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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT .DETAILSREPORT O ' MATION <br /> `I P`L t`1 Sampler(s): � l� 7y Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: °'� <br /> "{�^ Composite Sampler Setup: Subject to surcharge <br /> Customer Number: '," ! Date: Time: QA/QC report required: yes no <br /> 1 <br /> Address: 0' �3' � � v o Subject to Surcharge Field Sampler: IF yes,To: State Client Other <br /> Time Milage: Lab number: %0 C1 112C — <br /> Phone: � �� 32-f v 6G i 1 <br /> U <br /> 7 Z3 3 y <br /> FAX: 04"03-f_ 0-7 Sample Temperature: Celsus <br /> N f ( ) Leaking.( )Broken. ( )VOA Headspace <br /> Project name: » � g., a � � a�a � � � Custody Seal()yes ()no <br /> .O C i4 Ei SAMPLE N <br /> 11 z <br /> TRANSPORTATION. ■ • <br /> Contact person: V"` , 8 Q F o M <br /> z ° <br /> E v z 3 Ice Chest ( )UPS ( Wed Ex prop off ()Other <br /> INFORMATION <br /> • y u 4 as .7 > ^ / \ <br /> SAMPLE • UJ A Y.' M m � .� 0. d <br /> C p.. p V1 a 4 N o <br /> Sample Date Time o 3 3 3 x z • • ■ <br /> Location Description0 ME <br /> Number p Sample Sample z w c?3 6i a <br /> 'to� N 66 C 2 u z <br /> Y <br /> T3�cNF,� <br /> REMARKS CUSTODY <br /> Relinquished h Date L'Time . Received by: Datedime <br /> Relinquished by: Date Time Received by: :7FDate 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 />