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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Rush Analysis: 5 Days_2 Days_24hrs <br /> Client:�i6S N9 V 4-06(5�i(Lr Al Sampler (s : — <br /> omp site Sampler Setup: Subject to surcharge <br /> Customer Number: Date7-;j� Time: QA/QC report required: yes no <br /> Address: <br /> oex 3�< Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> Time Milage: Lab number: I()-4 <br /> Phone: 0 09—ADZ - 16 5-a SAMPLE CONDITION <br /> FAX: a a Sample Temperature: Celsus <br /> E a a <br /> Project name o z ( ) Leaking. ( ) Broken. ( ) VOA Headspace <br /> Pro UA9 6IZO N/Ao" eV� e F A b ° <br /> j ;, Custody Seal ( ) yes ( ) no <br /> Contact person:_[10&/ <br /> m z z <br /> 3 a 2 ( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off <br /> SAMPEE INFORMATION F e o )Other <br /> Sample Date Time <br /> Location Description <br /> Number Sample Sample z° w i �2 a A <br /> 2 n/ P vJ D P <br /> Z leio ' <br /> REMARKS OD <br /> Relinquished by: Date = ime 30Received by: Date--')/AZrime 1110 <br /> Relinquished by: Date mime Received by: Date Time <br /> Relinquished by: Date mime 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 Page 7 of 7 <br />