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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND_ANALYSIS REQUEST DOCUMENT <br /> I• 1 7qrequired: <br /> I 'j ,yMJr=( Sampler(s): I 1%NLQ Tpal s: 5 Days _2 Days_24hrsClient: . IL H'( Composite Sampler Setup: ubject to surchargeCustomer Number: �� Date: Time: yes_ no <br /> Address: P' © ' 3 n Z)yti Subject to Surcharge Field SEmpler: If yes, To: State—Client Other <br /> �;y."' �. 1 C-A I .S Z9- f Time Milage: Lab number: 60_28 `-I p " Q <br /> Phone: (q"^I) 33 l� - ('Cwl5SAMPILE CONDITION <br /> U <br /> s <br /> (Zog) 334• -vILi _ =3 = Sample Temperature: Celsus <br /> FAX: = e_ o s <br /> Leaking. O Broken. ( )VOA Headspace <br /> Project name: OR Custody Seal( )yes ( ) no <br /> o <br /> Contact person: 1 <br /> .. o� Z -m <br /> 3 9 a " (hIce Chest ()UPS ( Wed Ex (Drop off ()Others d \ <br /> °E d ties <br /> g m�3 <br /> Sample Date Timea rR d p Z° <br /> Location Description ;, - A <br /> Number Sample Sample z°> c <br /> i <br /> I I i I i <br /> CUSTODY <br /> Relinquis=ed be: f Date L� /Time /Z s' R�-:eked by: Dace k imeL' S-S <br /> Relinqu:s=ed by: Date _Time R�eived by: Date Time <br /> Relinquisced by: Date Time Re-eived by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-5105 * FAX: (209) 54--3-7497 * Email: jhvle@petallab.com * www.petallab.com <br />