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CLIENT DETAILS <br />Client: y c0145ut -i-w(7 <br />Customer Number <br />Address • 0 • 56 xt 37 q4- <br />1-cozt-ock- '4 .c?3,4/ 1 <br />Phone: e72.0 f- .40z-f4, <br />FAX: <br />Project flame' 4xiAirizy ia1 <br />Contact person: DA/ CJIE4/y61 <br />Rush Analysis: 5 Days 2 Days 24hrs <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: State Client Other <br />Lab number: <br /> 10; 11 IZ-0(/ 0 2__ Type of Sampling: Composite (C) Grab (0) ALL 1,1 P Wsiv <br />Date Time <br />Date Time <br />PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />SAMPLE INFORMATION <br />Sample <br />Number Location Description Date <br />Sample <br />Time <br />Sample <br />AND ANALYSIS REQUEST DOCUMENT <br />REPORT INFORMATION <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br /> <br />SAMPLE CONI)ITION <br /> <br />Sample Temperature: Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />SAMPLE TRANSPORTATION <br />( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off ( <br />Z <br /> )Other <br />ANALYSES REQUESTED <br />Composite Sampler Setup: <br />Date: <br />Time: <br /> (S) Soil (SLG) Sludge (SU)) Solid (0) Oil (1) NaOH = Zulic, (2) Ne0H, (3) HCI Preservativ (4) 112504, (5) HNO3, (6) Na2S203 (7) Other /A/FLut/yr /.31C TRH 7-c5, TL , P, p 1-1 /t/02:- A- <br />eOD- Arnit -fr A Lk— <br />347 /1.1 / / O wyJ <br />Relinquished by. Date 3 1 ne /CO 3 Received by <br />Relinquished by: Date Time Received by: <br />Relinquished by: Date Time Received by. <br />35 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com