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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: Z �'� tiny 4—P4 -r <br />Customer Number: <br />Address: 0 <br />Lo , TC/- c! c uj <br />Phone: -334--&(a 13 <br />FAIL': C� �1� 31q r 6-7 7-3 <br />Project name: OD"amu <br />Contact person: �-'LqLt- —1% <br />SAITIPILElaES". <br />TTIATION <br />Sample Date Time <br />Number Location Description Sample Sample <br />974 LIVJ OA,� R�i ,l.om. t/s 2z lZ � <br />f — <br />Sampler (s): <br />Composite Sampler Setup: <br />Date: Time: <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />Rush Analysis: 5 Days _ 2 Days__ 24hrs_ <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: State n ,,� Client Other <br />Lab number: zo' V J 1 <br />Sample Temperature' Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off <br />)Other <br />W / ­a 744.s A/ ` P <br />2 <br />Relinquished by:.. " =Date S Ti'me / `� 57 Received b - Date <br />—_--1 E <br />Relinquished by: Date ime __Received by ___ Date Time <br />j Relinquished by: Date ime Received by: Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvleQpetallab.com * wwAFPage 7 of 7 <br />a <br />x <br />" <br />a <br />N <br />z <br />.9W <br />z <br />° <br />A <br />e� <br />d� <br />� <br />a33 <br />O <br />�o <br />33 <br />2 <br />z>P%1 <br />w <br />Vic? <br />c4 <br />W <br />evw <br />Rush Analysis: 5 Days _ 2 Days__ 24hrs_ <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: State n ,,� Client Other <br />Lab number: zo' V J 1 <br />Sample Temperature' Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off <br />)Other <br />W / ­a 744.s A/ ` P <br />2 <br />Relinquished by:.. " =Date S Ti'me / `� 57 Received b - Date <br />—_--1 E <br />Relinquished by: Date ime __Received by ___ Date Time <br />j Relinquished by: Date ime Received by: Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvleQpetallab.com * wwAFPage 7 of 7 <br />