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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQ VEST DOCUMENT <br /> REPORTCLIENT DETAILS <br /> ■ <br /> MATION <br /> Client: U ;p Sampler(s): Rush Analysis: 5 Days _2 Days�24hrs <br /> LComposite Sampler etup: Subject to surcharge <br /> Customer Number: '"' c Date: Time: QA/QC report required: yes no <br /> Address: Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> Time Milage: Lala number: . <br /> M37_1 o 1- 0I <br /> Phone: q - 01 (4f , <br /> Sample Temperature: <br /> FAX: 20 C1 ►.� j - x P P Celsus. <br /> a ° a f }Leaking. ( }Broken. { }VOA Headspace <br /> C <br /> [] <br /> Project name: QM Yd. o F � U � ��A M � <br /> N Custody Seal{ }yes ( }no <br /> 3EA N <br /> 93 <br /> Contact person: -C 1 42 a; m <br /> m <br /> d <br /> 3 3 3 w )Ice Chest (}UPS Wed Ex ()Drop off ( )Other <br /> SAMPILE INFORAIIATION :0- AN <br /> Sample Date Time d a " 3 <br /> Location Descriptio R a 3� x <br /> Number P Sample Sample x a a °� A <br /> t Z - S <br /> CQ <br /> 'Pow <br /> CUSTODY <br /> Relinquished by: Date-1 2; Ti me_1_'Z__WLkReceived by: Date�Time I �� <br /> Relinquished by: Data 'Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 548-7497 * Email: jhvle@petallab.com * www.petallab.com <br />