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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING • . <br /> A <br /> � Rush Analysis: 5 DaysW2 Da 4hrs <br /> Chen0;/VJ& J <br /> )fit Sampler(s) — <br /> �`,/ /� Composite Sampler Setup: Subject to surcharge <br /> Customer Number: -���CO�Ld Date: Time: QA/QC report required: yes no <br /> Add ess: f l zz Glial Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> Time Milag e: <br /> !�V Lab number: <br /> Phone: ' LE CONDITIO <br /> � x <br /> FAX: C w R _ Sample Tem erature: <br /> p o P r, Celsus <br /> z <br /> r a M O Leaking. ( Bro en. ( )V0A Headspace <br /> Project name:_ z"I <br /> Custody Seal O yes O no <br /> Contact person: / / 'Cid o m 0 • • <br /> I'm a� a g3� z x <br /> ( )Ice Chest ( )UPS ( )Fed Ex )Drop off ( )Other <br /> SAMPLE • . . • w .a <br /> of 0 <br /> Sample 3 0 o <br /> p Date Time v B¢ w m N z <br /> Location Description 9 o 3 x . <br /> Number p Sa ple Sample F z> w a MNWdt <br /> I Df Z2 A 101r <br /> 114,4 A13 <br /> .�.� <br /> k�s. <br /> t4 D10 : CUSTODY <br /> Relinquished b Date 16�fime `'Receive 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 />