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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS .O . INFORMATION <br /> + 7Comipositel <br /> C— 71-3"-fRush Analysis: 5 Days _2 Days�24hrs <br /> Client• bi t-'.txj f MUS P <br /> 7arnpler <br /> amplerSetup: Subject to surcharge <br /> Customer Number:_ ) Date: Time: QA/QC report required: yes no <br /> Address: F 0, 50K 2,180 Subject to Surcharge Field Sampler: If yes,To: State ,Client �y Other <br /> CA ,S2-� Time Milage: <br /> Lab number: <br /> Phone: Ca) (� SAMPLE CONDITION <br /> Sample Tem <br /> CZoq) 33¢ d7Z3 3 _ P P <br /> 3 ,, a erature: Celsus <br /> FAX: 9 s z <br /> o d O Leaking. O Broken. ( }VOA Headspace <br /> Project name: 3 m a ( ) <br /> Custody Seal()yes no <br /> ZEF7 <br /> SAMPLE TRANSPORTATION <br /> Contact person: M i �"'� m z x o <br /> Wm� <br /> a d z 3 3 3 VIce Chest ()UPS ()Fed Ex Drop off ()Other <br /> SAMPLE <br /> Sample Date Time m g o a 3 3 3 m zANALYSES REQUESTED <br /> Location Descrip <br /> Number Sample Sample ztion & �,?- / a <br /> (ZOO N NUI -t f4). sPKCai c�+-� 4 to �� {V�o ��'V r1AVII Gt <br /> 7777 CUSTODY <br /> Relinquished by: Date r �LTime 7 Receiv d by: Date / T'me �' <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)477-5145*FAX:(209)546-7497*Email:Petal545@sbcglobal.net*www.petallab.com <br />