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CLIENT DETAILS <br />Client: '.UAc.te.v 41- 11/4-ik17 H <br />Customer Number: <br />Address• <br />St4<- : 22.0 z1 E - 'Thorcl Aswc Li4tvk1Ok <br />Phone: z_e - 3 `-f - (okvi <br />FAX: <br />Project name: P-0`.1 VeArc__ k-c* <br />Contact person: to3frt ,— <br />SAIVIPLE INFORMATION Is REPORT INFORMATION <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 /> <br />107V — DI <br /> <br />Sampler (s): <br />Composite Sampler Setup: <br />Date: <br />Time• <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />SAMPLING <br />Date -7-2-3-2rime 1 :00 <br />PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />Sample <br />Number <br />Noettiw•eAk- 2._20&t c ThdA.it.,LivkA.re‘ ouace-igiout <br />Location Description <br />V23 24 <br />Date <br />Sample <br />12:30 <br />Time <br />Sample Type of Sampling: Composite (C) Grab (G) P/v Okt (8) Soil (SW) Sludge (SW) Solid (0) Oil Preservative: (1) Na011 = ZnAc, (2) NaOH, (3) IICI (4) 112SO4, (5) 11NO3, (6) Na2S203 (7) Other AND ANALYSIS REQUEST DOCUMENT <br />Sample Temperature: <br />Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />SAMPLE TRANSPORTATION <br />( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off ()Other <br />ANALYSES REQUESTED <br />)1.-brite 11,4 6C P CS 04 <br /> <br />SAMPLE CONDITION <br /> <br />REMARKS <br />Relinquished by:7541;1'27- <br />Relinquished by: Date <br />Relinquished by: Date <br />Time Received by: Date Time <br />Time Received by: Date Time <br />Date7-23-2JTime 12 'SIP Received by: <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www. <br /> <br />Page 7 of 7