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M M M M M M M M ! M = = M = = M M M M <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFOPAUTION Is I <br /> Client: 11y�' / �t�Y� �,/ Sampler(s): L it -N M,-�qq Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Customer Number: <br /> T— <br /> Composite Sampler Setup: Subject to surcharge <br /> Date: <br /> Time: QA/QC report required: yea no <br /> Address:Ip' �y �� Subject to Surcharge Field Sampler: If yes,To: State—Client _Other <br /> Time Milage: <br /> Lab number: <br /> Phone: (�L" � <br /> s <br /> r � <br /> FAX: <br /> mx> z Sample Temperature: — Celsus <br /> s aim a <br /> ' 'a z )Leaking. ()Broken. O VOA Headspace <br /> Project name: EQ <br /> F Custody Seal()yes ()no <br /> s a €@g <br /> Contact person: M �`� �� z a • . <br /> 3 z sQY a <br /> 3 0 <br /> 3 a a d ()Ice Chest ( )UPS ( )FedEx rop off ( )Other <br /> Sample Date Time > E< m 3 € s x <br /> Number Location Description o 3a'g <br /> Sample Sample ti'' Z> fi m�3 r'n F a m_^ ADI <br /> Relinquished Date1141 Time ) 2'S D Received b . Dat e i2' Time 12 :-C <br /> � t <br /> �p Relinquished by: <br /> j Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received b <br /> o y: Date Time <br /> 8 3935 N. Coronado Ave. * Stockton CA 95204 " Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />