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PRECISION ENVIE,( -TECH <br />t _ <br />Client:` rit,� ��inz �I iLeJ <br />Customer Number: Cl—L <br />Address: �? L� �� �� cG P6�21_eZ <br />c� <br />Phone: C 4�L°{11,4, z 3Z7 <br />FAX: �2 �'/ �% C Z16' <br />Project name.�� <br />Contact person: LC '✓/S/ <br />Numple ber Location Description Date Time <br />s" <br />ple Sample <br />Relinquished b:•: <br />Relinquished by: <br />Relinquished by: <br />CHAIN OF CUSTODY <br />AND AATALYSiS REQUEST DOC• U.-IfE TT <br />Sampler Setup: <br />Time: <br />Rush Analysis: 5 Days _ 2 Days _24hLrs <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: Sts <br />t� Client Other <br />C�ZL/ 7 <br />Lab number: <br />"-- Date 7 <br />Date Time <br />Date Time <br />Received <br />Received <br />Date Time <br />Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477.8105 * FAX: (209) 546-7497 =k Email: jhvle@petallab.com * www.peWlab.com <br />3 <br />"�, <br />Sample Temperature: y, S C_ Celsus <br />'C <br />cU <br />t Leaking. (j Broken. ( j VOA Headspace <br />F <br />� <br />n <br />° <br />J <br />Custody Seam <br />_ <br />Fr <br />J.• <br />7 <br />C <br />y <br />yes !) no <br />° <br />o <br />o <br />z <br />Ice Chest <br />z <br />z <br />o <br />()UPS ( )Fed Ex ( )Drop off ()Other <br />q <br />til <br />Z <br />3' S <br />m <br />„N'-,. <br />ro <br />D1 I <br />"-- Date 7 <br />Date Time <br />Date Time <br />Received <br />Received <br />Date Time <br />Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477.8105 * FAX: (209) 546-7497 =k Email: jhvle@petallab.com * www.peWlab.com <br />