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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND_ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> c Vi;/;L + Sampler(s): -6- - � ! Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: 1�� ��J 1 <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address:— , Subject to Surcharge Field Sampler: If yes,To: State—Client _Other_ <br /> Time Milage: Lab number: <br /> r <br /> Phone: i 7o f� �i 34 - i� 13 s j • • ON <br /> l^ 7 -77 7 a m Sample Temperature: Celsus <br /> FAX: / ;a3 c s <br /> c� ° o <br /> s z ( )Leaking. ( )Broken. ( )VOA Headspace <br /> Project name:__2 J �` ' ` rJr " z AV <br /> W 8 Custody Seal ( )yes ( )no <br /> He <br /> e " ' <br /> a x � <br /> Contact person: �•/i "'� z y s Z <br /> a 3 2 ()Ice Chest ()UPS ( )Fed Ex ()Drop off ( )Other <br /> 6 x"j <br /> 4 Z°" <br /> Sample Date Time " I <br /> dry A <br /> Number Location Description sample Sample w god <br /> AA Pl 7- <br /> J�7 �4'Purdq 1 0. T74-/L,'. �' �O: 3. � � � i�%n F',' ��, �J` Ott Iv:'r-�.?� <br /> I <br /> CUSTODY <br /> "_-' r Date =/%7 `'rime f }:!j. dRe•eived by: `�i E�*r Date-' .9w1�ime <br /> Relinquished by: - <br /> Relinquis`ed by: Date _Time Re ived by: Date Time <br /> 777 "Relinquished by: Date _Time Reneived by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone 1 <br /> 209) 477-8105 * FAX: (209) 543-7497 * Email: jhvle®petallab.com * www.petallab.com <br />