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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND_ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS ' <br /> MATION <br /> 11 Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: AGV O.a(1 LQ� C-j V e(yC"V 1✓0 VYds n 4(!y Sampler(s): �6 ►� C� <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: A C7 Date: <br /> Q Time: QA/QC report required: yes no <br /> Address: '2 SX14.-W I OCt Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> Seo c.k�c1 <br /> C A �y 5, 2 15 Time image: Lab number: ��U O Co Z � 0 <br /> "t <br /> Phone: Z Q u (-4 - 100 <br /> G z ' • • i <br /> s � V <br /> a s Sample Temperature: Celsus <br /> m <br /> FAX: 6 0 <br /> J name: n�c M Leaking. ( )Broken. ( )VOA Headspace <br /> Project e 14, a .-- N Custody Seal( )yes ( )no <br /> Contactperson: 1 1- <br /> a 3 a Ice ()UPS ( )Fed Ex ()Drop off ( )Other <br /> e ey u <br /> 11 <br /> SANIPILE INFORMATION <br /> Sample Date Time g 6 a a v 333 z <br /> Number Location Description Sample Sample F z'O mn3 • • A <br /> EAST -zmi — S $Z C r11 C 26 Fu <br /> R. <br /> r d <br /> I L <br /> j I 1 f <br /> rn V <br /> Relinquished by:W Date lgime Re-ceived by: Dateimea 36 <br /> Relin uis_ad b Date ime eived b � �_Date�� -'-�- <br /> i ""ime ' <br /> Relinquished by: Date Time Received by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 54-3-7497 * Email: jhvle®petallab.com * www.petallab.com <br />