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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> m AND ANALYSIS REQUEST DOCUMENT <br /> z <br /> REPORT INFOUNUTION <br /> m <br /> w <br /> Ick 'r bl _ Rush Analysis: 6 Days _2 Days 24hrs <br /> 0- ient' �Iand AA%J0 Sampler s .Cl , <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QAfQC report required; yes no <br /> Address: 30X Zk ° Subject to Surcharge Field Sampler: If yes,Tc: State Client Otber <br /> s 2 Time Wage: <br /> Uuo ch Lab number., <br /> F@_�� 534-(M3 _ <br /> w Phone:- _ <br /> 0 <br /> H 33 ��Z3 V Sample Temperature: Gelsus <br /> �x� P P <br /> s o <br /> w ; N ( )Leaking.()Broken. ( )VOA Readspaee <br /> Project name: 5 Custody Sea] ( )Yes ()no <br /> H a <br /> z <br /> Contact person_ `ti's - <br /> 4 ' l- i z D <br /> ' G 6 <br /> ` d D Ice Chest ()UPS ()Fed Ex Drop off ()Other <br /> d� xis <br /> H ; <br /> Sample Date Tim$ x �c Q :me r x <br /> Number' Location Desariptic+n Sam le .ample �. z> w <br /> �4uc EC @ f YNR Sfu#fAr l� �� /x; O <br /> c . . <br /> �o <br /> e <br /> tri 1 <br /> m f <br /> m <br /> EV' <br /> in <br /> m <br /> m <br /> CD relinquished Date 9��J-lTime �`Oo Received by: DsteTirne %00 <br /> c*r <br /> - Relinquished by: Date Time P.eceived by: Dete Time <br /> m Relinquished by: nate Tmie Received by: Date Time <br /> 3935 N.Corona&Ave. Stockton CA 95204 Telephone(209)477-8105* FAK(209)546-7497*mail:Pet215450sbeclobalmet*www.petaUab.com <br />