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PRECISION ENVIRO - TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS <br /> ' REPORT INFORMATION <br /> Chen /� � �,� A,/� Sampler ( s) : Soo" Rush Analysis : 5 Days 2 Da _ 4hrs <br /> M6 Composite Sampler Setup : Subject to surcharge <br /> Da <br /> Customer Number: CJ� _� <br /> te : Time : QA/QC report required: yes / no <br /> Address : (Y /'ZfjtC Subject to Surcharge Field Sampler : If yes , To : State Client ✓ Other <br /> 45 q , Time Milage : CA (3 V1 15 3 - C I <br /> ` iz Lab number: <br /> Phone : SAMPLE CONDITION <br /> Poo <br /> FAX: Zed 9d � x R _ Poo <br /> m Sample Tem erature : fd Celsus <br /> R' oqf o z o r <br /> e c OLeaking. ( Bro en. ( j VSA Headspace <br /> Project name : 4 �ifA N 6 9 N <br /> F " ¢ Custody Seal O yes O no <br /> J W SFO G N m <br /> Contact person : <br /> m aF z z o <br /> PLE <br /> • • ( )Ice Chest ( )UPS ( )Fed Ex (() Drop off ( )Other <br /> SAM <br /> m \ <br /> Sample Date Time c ¢ a° z <br /> Number Location Description Sa ple Sample F z > a v ? m 0. ♦ ♦ IkA' A <br /> xf <br /> 49&w&n4y 's g <br /> �S. <br /> CUST <br /> OD <br /> 7 77 7 Relinquished b Datey ime ` ` 1IReceive _77 <br /> Date Time <br /> Relinquish by: Date Time Received b Date Time <br /> Relinquished by: Date Time Received by: Date 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 />