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M _ _ _ _ _ _ _ _ _ CHAINOFMCU CUSTODY <br /> _ _ _ <br /> PRECISION ENVIRO-TECH <br /> AND_4NALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT IT&• ' • <br /> tlA 1 'ro Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: t> j 11 cn tAvrp % Sampler(s): `( — <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: (Z-18- If30 <br /> Time: - QA/QC report required: yea no <br /> Address: P' U ' Pix Z 120 Subject to Surcharge Field Sampler: If yes, To: State_Client Other <br /> C4 `1 S Z4 Time Milage: <br /> Lab number: <br /> Phone: =kenOA <br /> • <br /> s - <br /> E5 <br /> FAX: (Z0 �) 3i4- o�23 �;a _ = Sample TeCelsus <br /> e ( )Leaking. () ace <br /> Project �1�4NNECa0IAJi 6 <br /> J m c ° Custody Seal( <br /> 9 z <br /> Contact person: �`'�/ l4E 7y'l � �� _ ` o '° � • <br /> ()Ice Chest ( )UPS ()Fed Ea ODrop off ( )Other <br /> SAMPLE INFORMATION <br /> � m N <br /> Sample Date Time '�a � $ z° <br /> Location Description <br /> Number Sample Sample z'> n m� m <br /> fiicCre w:. 2601 u �v�� 9 ► v u _ _ - - p G <br /> CUSTODYK <br /> Relin uis_ed Date ?'�'ai{ 7- SQ,Q <br /> q Time Re^_eived by: Datell Zerime <br /> Relinquis`_ed 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) 477-8105 * FAX: (209) 543-7497 * Email: jhvle@petallab.com * www.petallab.com <br />