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.PRECISION ENVIEO-TECH <br />Client:',*o q, _ rJy+ti�.c L;.11 2 <br />Customer Number: L <br />Address: 3 105-S -DOVAksp IQ- <br />- C A 952ci <br />Phone: 20 9 - L1 6G - G,3 2 L4 <br />FAX:— 1(39 -- <br />Project <br />09_ -Project name:_13�s_}� <br />Contact person: <br />Sample <br />Number Location Description <br />Dat <br />Sam D <br />CHAIN OF CUSTODY . <br />AND ANALYSIS REQUEST DOCUMENT <br />REPORT INFORMATION <br />Sampler (s):(,k �;S I Rush Analysis: 5 Days _ 2 Days _24hrs_ <br />Composite Sampler Setup: <br />Date: Time: <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />e Time <br />le Sample ; F <br />101 '.274 C7 <br />toI 9'301 G <br />Subject to surcharge <br />QMQC report required: yes no <br />IF yes, To: State __ _ Client _ Other <br />Lab number: Q 093 4014 – G (- n <br />Sample Temperature: 5 0 � Celsus <br />( ) Leaking. () Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes O no <br />XIce Chest ( )UPS ( )Fed Ex ( )Drop off ( )Other <br />P1 << 4 - <br />Relinquished birL�- � ► Dat-10311,Time *! Received by: _ Date fd Time C1 :34i <br />Relinquished by: _ _ Date Time Received by: <br />Date Time <br />Relinquished by __ Date Time Received by: Date <br />Time <br />Stockton CA 95204 * Telephone (209) 477-8105 * FAR. (209) 546-7497 * Email: ihvle@petallab.com * www.petallab.com <br />i <br />G4Y <br />o <br />z <br />o <br />— <br />xqE` <br />A <br />E <br />Xte <br />O <br />N' <br />a <br />5' <br />pO� <br />z <br />m <br />j <br />Y <br />Z <br />Subject to surcharge <br />QMQC report required: yes no <br />IF yes, To: State __ _ Client _ Other <br />Lab number: Q 093 4014 – G (- n <br />Sample Temperature: 5 0 � Celsus <br />( ) Leaking. () Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes O no <br />XIce Chest ( )UPS ( )Fed Ex ( )Drop off ( )Other <br />P1 << 4 - <br />Relinquished birL�- � ► Dat-10311,Time *! Received by: _ Date fd Time C1 :34i <br />Relinquished by: _ _ Date Time Received by: <br />Date Time <br />Relinquished by __ Date Time Received by: Date <br />Time <br />Stockton CA 95204 * Telephone (209) 477-8105 * FAR. (209) 546-7497 * Email: ihvle@petallab.com * www.petallab.com <br />