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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT, IETAILS ' SAMPLING REPORT • • <br /> Client: Sampler(s): =v Rush Analysis: 5 Days _2 Days_24hrs <br /> pi� `�� � M��P�•-1 M�( L6^ '1 <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: M Date: Time: QA/QC report required: yes_ no <br /> Address: P 0 Box Z1 9 V Subject to Surcharge Field Sampler: If yes,To: State—Client _Other <br /> O'' l C4, q )s f Time Milage: Lab number: <br /> Phone: C��� 3 3`1– 6(o o z • • • <br /> FAX: 33`�'V7Z 3 0 bra x Sample Temperature: Celsus <br /> p a gmo 5 z o <br /> p a F )Leaking.( )Broken. ( )VOA Headspace <br /> Project name: 0 4 o <br /> s s F c $ Custody Seal()yes ( )no <br /> p N <br /> Contact person: • • <br /> .�F � ms`s z" o • <br /> SAMPLE • ' • • t 3 q s y Ole <br /> Chest ( )UPS ()Fed Ex 1 Dro off <br /> - p Other <br /> Sample Dae Time o <br /> � n o <br /> Location Description <br /> a rs z° <br /> Sample Sample z> o �? i .� A •� • <br /> b N GL-FJt'6-�ET Q Rb B Lt?6 7�1�/� ��.' 3i7 C' _ <br /> CUSTODY <br /> uished <br /> Relin ZrI <br /> 4 Date7_Time L2' y Received by: DatelWbbpime V <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: jhvle@petallab.com * www.petallab.com <br />