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RECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: <br />A!stomer Number: <br />o <br />Address: <br />31 <br />.?hone: <br />?roject name:-; '' L`' r'— <br />Contact person: <br />Sample I Location Description <br />Number <br />51 Iii <br />Date I Time <br />! Z' y& <br />Sampler (s):, <br />Coposite Sampler Setup: <br />�. <br />Date: 2-'— 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 Client Other <br />Lab number: '27p)-0413-61 <br />•CUSTODY <br />Relinquishes)-b� / �-� Da et "I , T�me L � Received by ';� Date ime 3 <br />Relinquished by: Date Time Received by: '� Date Time <br />Relinquished by: Date Time Received by: Date ► ime <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvleQpetallab.com * wwwl Page 7 of 7 <br />mm <br />0 <br />Sample Temperature: Celsus <br />4 <br />a <br />o <br />x <br />z <br />o <br />m! <br />! <br />O Leaking. O Broken. O VOA Headspace <br />a <br />�a <br />b <br />o <br />Custody Seal () yes () no <br />A <br />z <br />z <br />' IM -11,64 <br />5 <br />p <br />)Ice Chest ( )UPS ( )Fed Ex ( )Drop off <br />e 3 <br />a <br />)Other <br />•CUSTODY <br />Relinquishes)-b� / �-� Da et "I , T�me L � Received by ';� Date ime 3 <br />Relinquished by: Date Time Received by: '� Date Time <br />Relinquished by: Date Time Received by: Date ► ime <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvleQpetallab.com * wwwl Page 7 of 7 <br />