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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORT('LTENT DETAILS SAMPLING . <br /> Client:�� LI e-1Ilip , k _, ONTT 10& Z7 s_Rush Analysis: 5 Days_2 Day24hrs_ <br /> r"�-�� Sampler (s <br /> I Composite Sampler Setup: Subject to surcharge <br /> Customer Number: p I� — Date: Time: QA/QC report required: yes no <br /> Address:—)-51 -75I} I E ^D C Subject to Surcharge Field Sampler: If yes,To: State_ Client_ Other <br /> Time Milage: i () <br /> j Lab number: <br /> Phone: (o I3 ILI <br /> tL� p x <br /> FAX: 4. il� �Y 1 b�l h e2,�"!tQi ��£ = Sample Temperature: Celsus <br /> j a m S p <br /> � 0 ° O <br /> z c ( ) Leaking. ( ) Broken. ( ) VOA Headspace <br /> Project name. v ESA h Custody Seal O yes O no <br /> z <br /> Contact person: Q� `�/� a m <br /> v, er z <br /> B 3 a N OIce Chest ( )UPS ( )Fed Ex ( )Drop off <br /> _ )Other <br /> Sample Date Time <br /> Location Description o a a <br /> Number p S mp a Sample <br /> u ( Gad J I tI: <br /> gt <br /> 19MR114 CUSTODY <br /> L ,1 <br /> pi Relinquishedb . Date a IY 5 Received by: Date 1 imeCD <br /> V Relinquished by: Date ----Time Received by: Date Time <br /> o Rehnquishedby: Date Time Received by: Date Time <br /> -4 7 <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />