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9 <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS-REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS I ' <br /> �I l�l�iu,.� M u � Y ► ;FRush Analysis: 5 Days _2 Dayss_24hrs <br /> l <br /> er(8): KA <br /> Client: <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number:_ Q Date: Time: QA/QC report required: yes no <br /> Address: Subject to Surcharge Field Sampler: t} If yes,To: State Client Other <br /> G4 <br /> Time Milage: <br /> Lab number: L 1 O p� Q <br /> Q t 1 <br /> 1. <br /> Phone: Zvy �3. - 1�r3SAMPLE CONDiTiON <br /> ;1 <br /> FAX. C7'q) 334_07Z� _ o Sample Temperature: Celsus <br /> m sm � ° z <br /> Leaking. ( )Broken. { )VOA Headspace <br /> Project name: Pit)5 f4, d 3 Custody Seal()yes ( }no <br /> NSPORTG % AMPLE • <br /> Contact person: 92 <br /> z g <br /> Vice�', hest { )UPS ()Fed Ex Prop off ( )Other <br /> SAMPLE 1NF0.RMATt0N <br /> = � 3 <br /> Sample Date Time w a �' 3 • <br /> � z <br /> Number Location Description Sample Sample z° a S <br /> � N JnJ7_,1 <br /> 1J <br /> !f {II <br /> -4€ <br /> �I <br /> 4 <br /> CUSTODY <br /> r�0 _ <br /> 777 -7 , Relinquished b Date. Time Received by: Date "l ime Z S <br /> Relinquished by: i Date -Time-Received by: , Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> R <br /> 3935 N. Coronado Ave. *Stockton CA 95204*Telephone(209)477-8105*FAX:(209)546-7497*Email: Petal 545@sbeglobal.net*www.petallab.com <br />