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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Client��Kl�l� � /� �„ J � Sampler(s): Rush Analysis: 5 Days _ 2 Days_24hrs <br /> ( /�' � <br /> ,p Composite Sampler Setup: Subject to surcharge <br /> Customer Number: 45OX G Date: <br /> ll,,�� `` /� __ JJ '' � Time: QA/QC report required: yes no <br /> zyAddress:_ [ , 1�/y Subject to Surcharge Field Sampler: If yes, To: StateClient Other <br /> '' <br /> Time Milage: Lab number: C\0 Q(5 — Q ! <br /> Phone: c�' . 66. o'ZO�W <br /> S _ x <br /> 3 m <br /> FAX: �'• ��l•� � �; a 3 _ x Sample Temperature: Celsus <br /> U c <br /> a swm ° z o <br /> a x ° t Leaking. () Broken. ( ) VOA Headspace <br /> Project name: �_ 9� k v3o > <br /> ° Custody Seal O yes O no <br /> S 0 to Q N w <br /> a z <br /> 5 a x ° • rIR DO • , r ,J ,,JJ <br /> Contact person: 1 !�/l5 ° <br /> [F zy z o <br /> z v A a v ()Ice Chest ()UPS ( )Fed Ex Drop off ( )Other <br /> SAMPILE • RMATI , rn F <br /> Sample Date Tima 3 d ° <br /> Number Location Description e 0 3 3g x z • • r <br /> Sample Sample h z> a. �, 3 m a A <br /> • V.1 CUSTODY <br /> yy�� <br /> Relinquished by. Date ime��(�Received Date j ime <br /> Relinquished by: Date Time Received by: 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 />