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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUM VT <br />Client: C L t , , . , , 1 , 11l <br />Customer Number: <br />Address: <br />Sampler (s): <br />Composite Sampler Setup: <br />Date: Time: <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />Phone: <br />Date' l : <br />s <br />-.k Received by: <br />Date <br />Relinquished by: <br />V <br />Time <br />Received by: <br />Relinquished by: <br />FAX: <br />Time <br />Received by:. <br />a <br />_ <br />=m <br />s <br />a <br />z <br />o <br />Project name: <br />G <br />a <br />1 <br />2 H <br />o <br />o <br />Ca <br />-Fa <br />q <br />Contact person: <br />v <br />o <br />V <br />A <br />`� <br />z <br />m <br />e <br />GF <br />z <br />5 <br />z <br />o <br />SAMPILE INFORMATION <br />W <br />R <br />Date ate <br />Number Location Description <br />Time <br />m <br />E < <br />Q <br />_ <br />i <br />Sample <br />Sample <br />z' ° <br />is <br />Rush Analysis: 5 Days _ 2 Days_24hrs_ <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: State Client Other <br />Lab number: <br />Sample Temperature: Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes--( ) no <br />( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off ( )Other <br />I <br />Relinquished by: <br />Date' l : <br />_.Time <br />-.k Received by: <br />Date <br />Relinquished by: <br />Date <br />Time <br />Received by: <br />Relinquished by: <br />Date <br />Time <br />Received by:. <br />Date <br />' Time <br />Date <br />Time <br />Date <br />Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />