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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND_ANALYSIS REQ UEST DOCUMENT <br /> REPO <br /> . INFORMATION <br /> DETAILSCLIENT <br /> 1 t� Rush Analysis: 5 Days _2 Days_24hrs <br /> Client:_ A d� 10. C�d ��Y P(�t Y? rte_ �C.1-MCC Pler(s): <br /> Subject to surcharge <br /> C Composite Sampler Setup: <br /> Customer Number: pp Date: Time: QA/QC report required: yes no <br /> S Y1 V,7 l'Q Q, q Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> Address: (� <br /> S�C0 C KAz n C1� q'S Z 1 —S Time Milage: Lab number: S <br /> Phone: —E09 L-1 ) 00 6 • / 0 1 LOSE <br /> s o � <br /> a s Sample Temperature: Celsus <br /> FAX: b <br /> E w x o z <br /> v E: - N ( )beaking.( )Broken_{ }VOA Headspace <br /> Project name: <br /> S p 3 S Custody Seal()yes ( )no <br /> ^y N <br /> o . z TRANSPORTATION <br /> 0. SAM <br /> Contact person: � , 1 d�N� �..l to .8 <br /> o <br /> y 99z �5� z` �7oI <br /> q <br /> a a ()Ice Chest ()UPS ()Fed Ex ( )Drop off ()Other <br /> Sample Date Time < a ar �i z . =21 11 pit <br /> ■ r <br /> Number Location Description Sample Sample z'> ° �v <br /> ANN&%, nil2'. C — S — NIZ <br /> 0 2 C Ml gZ .s+ <br /> Gr <br /> ►z 2 .G2 - - S - <br /> 12 <br /> OD <br /> Relinquished by: DateSCime ZII QP'I Re^eived bv: '71Date)ZJDZISTime <br /> 7777Relinqu;z'_-ed by: C, Datef 241 ime ' 6 IRe:eived by: Date L2LGIJIixne 2 '4 CeAl <br /> Relinquished by: Date Time Re=eived 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 /> ..__. ---- -- ._._.._----- — <br />