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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS • oil . REPORT , <br /> Client: �t On my -( h`� Sampler(s): 1 oLTQ l,) i hush Analysis: 5 Days _2 Days_24hrs_ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: I <br /> Time: __ QA/QC report required: yes - no <br /> V , <br /> Address: � � Zl `�V Subject.to Surcharge Field Sampler: I If yes,To.`State Client Other <br /> i 2 Time Milage: q as �}10� —Q <br /> (.100 ` 1 ��T � � �1 — Lab number: <br /> Phone: 5 SAMPLE CONDITION <br /> FAX: Cli S) 73y— D 7 Z- <br /> I Sample Temperature:a c p P Celsus <br /> e <br /> •o>_ ° � f. )Leaking. OBroken. ( )VOA Headspace <br /> Project name: f"�440Custody Seal(}yes ( }no i <br /> r a <br /> V o F A N m <br /> n z , • , ■ <br /> Contact person: `��=_!�� ------ - r o <br /> a. •`� z Sag` z O <br /> c3� I v )Ict C ,;:•" )UPS ( )Fed Ex Y)rop off ( )Other <br /> SAMPLE <br /> • ■ • , of <br /> ' Date Time !� <br /> SampleL <br /> Number oc t•on Description ,0 3 <br /> Sample Sample 1P <br /> it CUSTODY <br /> Relinquished by:—'o'— Date `'i'iine Z-W Received by: Date'C tme <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) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />