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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> SAMPLINGCLIENT DETAILS REPORT <br /> Flusnayss: ays 2 4hrs <br /> Clienl�!/r1/:Q ,� �1IC Sampler(s): U h Ali5 DD — — <br /> (�, Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: ._ QA/QC report required: yes no <br /> Add ess:��1� ���L?1'j (,j[/Z� Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> 4 <br /> ' F Time Milage: Lab number: C1�Ul I SQ 3 - Q <br /> Phone: 6�Ie/ r� �Cf '� ' EE CONDITIO <br /> d <br /> x <br /> FAX: Sample Tem Brat j� / Celsus <br /> ww � ° z o <br /> l� w x ( ) Leaking. ( Bro en. ( )VSA Headspace <br /> Project name: ZeAl U ���y�s / <br /> %Z'rciL''as7 �' co <br /> _�•-- 3 F Q _ Custody Seal( )yes ( )no <br /> Fq 91 N m <br /> z ■ ■ <br /> us) <br /> • ■ <br /> P G. x m • ♦ ♦ • <br /> Contact person: � S � �,� o v ; ° <br /> z o <br /> 6n 'yF z z <br /> � 333 � x <br /> SAMPLE c a V ( )Ice Chest ( )UPS Wed.Ex )Drop off' ( )Other <br /> • • • of FSS m <br /> Sam le 0 a ° `�3 o <br /> p Date Time d w W z <br /> Location Description 0. =0 3 a x <br /> Sa ple Sample z> w A <br /> Number P w ° m F • • ■ , <br /> y s /P _ — - <br /> CUST <br /> OD <br /> f'i 1 ,f�� <br /> Relinquished b Date ime Receive Date / l�Time <br /> Relinquish by: Date Time Received b Date Time <br /> O_ <br /> Relinquished by: Date Time Received by: Date Time <br /> 935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br /> ------ ------ - - - - - - - - - - - - - - - - — <br />