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PRECISION E NVIRO-TECH CHAIN OF CUSTODY <br /> AND-ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT INFORMATION <br /> DETAILS Pler(s): <br /> Rush Analysis: 5 Days _2 Days`24hrs <br /> Client: A c� <br /> Subject to surcharge <br /> C Composite Sampler Setup: <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: <br /> s�aV7 �O Q Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> (� <br /> S iO G K�� ►1 C 2 -S Time Milage: Lab number: <br /> Phone: 2 D9 if 93 Luej <br /> S <br /> h <br /> a _ Sample Temperature: Celsus <br /> FAX: <br /> N ( )Leaking.( )Broken. ( )VOA Headspace <br /> Project name:. _S-+cPc_k+oa Custody Seal()yes ( )no <br /> Jp N <br /> Contact person. J¢ <br /> $ ° <br /> e 9� z 15� � z o <br /> 3 3 ")IceChest )UPS ()Fed Ex ( )Drop off ()Other <br /> SAMPLE INFORMATION <br /> Date Time C' al Z • - <br /> Sample Location Description Sample Sample z' w T S T o m <br /> Number <br /> Z'. C -- S — " ` 236, C N l g Z s�- <br /> rz i 2G2C - — S - - <br /> Sz <br /> ltaz <br /> i <br /> Date��l ime Z11 R�eived by: Date l� Time d <br /> Relinquis�ed be: + <br /> 777Relinquis'_-ed by: Datel2 a4f ime Received by: Date 2.GZ I ime 2 '4 M <br /> Relinquished by: Date Time Rezeived 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.con <br />