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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />, <br />Client: 067-(tl�f/11*0- �Ci'yL/� fit—" <br />Customer Number: (( r // <br />Address: 3lo6- Vs L=L <br />2 0�4 <br />Phone: <br />FAX:1 3o b <br />6 � <br />l / <br />Project name: <br />Contact person: <br />Sample I Date I Time, <br />Number Location Description S$anple Sample <br />REM"KS <br />Relinquished hy: <br />Relinquished(by <br />Relinquished by <br />AND ANALYSIS REQ UEST D0C'UMENT <br />Him <br />REPORT INF ORMATION <br />ISampler (s): Rush Analysis: 6 Days _ 2 Days _24hrs _ <br />ompoit <br />� s Sampler Setup: `� Subject to surcharge <br />Date: 6 - Time: : ,�4%" / QA/QC report required: }res <br />-k—no <br />Subject to Surcharge Field Sampler: If yes, To: �Client -zj�-- Other <br />Time Milage: <br />Lab number: <br />Date /Time q'. Cl. <br />/ ��Reeceived <br />Date 9 /Y- 'iYe'ceived by-., <br />Date Time Received by: <br />Dat��Time qs <br />Date4Time <br />Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 '# EmaiI: jhvle@petallab.coin * www.petallab.com <br />i; <br />C <br />Sample Temperature: l G Celsus <br />} Leaking. () Broken. ( ) VOA Headspace <br />s <br />- <br />a F 3 <br />Custody Seal yes () no <br />o <br />= <br />w <br />r <br />0 <br />0 <br />a n <br />Xce Chest ( )UPS ( )Fed Ex ( )Drop off ( )Other <br />�/ ( <br />E- <br />Z > <br />y a v <br />� <br />cc <br />• , <br />P <br />.F <br />t�� <br />� <br />�TS s <br />Date /Time q'. Cl. <br />/ ��Reeceived <br />Date 9 /Y- 'iYe'ceived by-., <br />Date Time Received by: <br />Dat��Time qs <br />Date4Time <br />Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 '# EmaiI: jhvle@petallab.coin * www.petallab.com <br />