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SION E-NLVIERO-TECHCHAIN OF CUSTODY <br /> AND ANALYSIS.REQUEST DOCUMENT <br /> REPORT INTOMUTION <br /> Client: DI UJL- ,J V G,-Q,� Rush Analysis:sis: 5 DaysSampler(s): � _2 Days_24hrs_ <br /> Co r Su <br /> T �, Composite Sampler Setup: bject to surcharge � <br /> Customer Number: Q `' � ' Date: <br /> Time: QA/QC report required: yes no <br /> Address:_ C • ,X A 8J Subject to Surcharge Field <br /> g Sampler: If yes,To: State Client Other <br /> _1 Time Milage: <br /> ""s J Lab number: <br /> Phone: (?vg 3��-- � <br /> 17 <br /> i � M <br /> ��!' ` Sample Temperature: Celsus <br /> O <br /> _. -7 _ 0 m I ()Leaking. )Broken. VOA HeadspaceaceProject name:- <br /> Custody Seal() es <br /> NFq A N c�i.� <br /> Y no � <br /> I N 10. z ( . r <br /> Contact person.: 1iG � �p 1 v x � I1 � A i <br /> o i sV 333 <br /> • BY <br /> Ice Chest <br /> ltPS )Fed Ex (j <br /> Lrop of �Otl e e. <br /> Sample ToNDate <br /> Number I .��O : ;L: r .ipI me <br /> �r x <br /> Sa:t:ale Sample F z'y a r. a" v I • a <br /> I <br /> 61� I <br /> PZ W <br /> 6 60 , <br /> i <br /> ! i I <br /> I I � <br /> i <br /> c i I I <br /> fa ` J <br /> r Q Relinquished 1, Date:b/' Ifime_12 Y� Received v; C <br /> A' Date Time <br /> CD Relinquished by: Date Time Received by: <br /> v Date Time <br /> o P 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®petaHab.com * www.petallab.com <br />