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800 E. Main Street, Stockton ; SR0073144 <br /> RO-TE CHAIN OF CUSTODY <br /> PRECISION ENVI AND ANALYSIS REQUEST DOCUMENT <br /> REPORT OFORIVILATION <br /> Rush Analysis:5 Days_2 Days_24hrs <br /> sampler(s): � <br /> /� �I n s e d `, ,1 n c Subject to surcharge <br /> Client: i Composite Sampler Setup: <br /> Customer Number: <br /> A. C Date: Time: QA/QC report required: yes no <br /> pQ Q _1 Subject to Surcharge Field Sampler: If yes,To:State—Client _Other <br /> Address:-1-71-2--S�a w I�� Q Time Milage: <br /> Loc kl- C c -2I-5 Lab number: <br /> - L)G - 100 • • • <br /> 1 Phone: '7-09 — s = <br /> a Sample Temperature: Celsus <br /> V V c 3 p 2 <br /> {� FAX: = d e o z a <br /> V r = O Leaking.O Broken.( )VOA Headspace <br /> 1 I ,� r - <br /> Project name: C A'+�+ Z� S 1 o c_K� 0✓1 � � _ 3 0° 3S � � Custody Seal()yes ()no <br /> y N <br /> \^' <br /> Life f <br /> Contact person: yV l � ►6�hn1 2 s s z <br /> 3 _ ()Ice Chest ()UPS ()Fed Ex ( )Drop off ( )Other <br /> INFORMATION Z <br /> e Jia_ <br /> Sample SAMPLE Date Time g< < 3• z • • • A <br /> Number cation Description Sample Sample z'° a N o t ? a _ <br /> 2 Z 4 7 C t TOO Z 0 CAN 11, Ly L SZ <br /> C - S — - D I Id - <br /> 1t - <br /> i <br /> i <br /> ' ' <br /> Relingws.ed b�- G Date t lime Z '1 1N11 R�eived by: Dat iZ Time 1��P <br /> 11eltngc:;_ed by Date Time Ren:eived by: Date Time <br /> 1elinquis=ed b) Date Time Re�:eived by Date Time <br /> 3935 N. Coronado Ave. # Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 54-3-7497 * Email: jhvleQpetallab.cotu * www.petallab.c( <br /> Page 16 of 20 Photo taken on December 2, 2015 <br />