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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: 0;110A) <br />Customer Number: <br />Address: `J q7 N• <br />�-ZQz-'i� <br />Phone: <br />Sampler <br />Composite Sampler Setup: <br />Date: Time: <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />FAX: ��-f�f�ti�EL�GGONFND1Ku2P�y. <br />�; <br />s <br />A <br />& <br />z <br />w <br />o0 <br />s A <br />o <br />b <br />x <br />z <br />M <br />° <br />- <br />Project name: Z Z <br />( )Ice Chest ( )UPS ()Fed Ex ( )Drop off <br />)Other <br />s <br />E5 <br />Time <br />Sample <br />�:�s <br />a <br />z <br />Contact person: Yr-a&ty <br />o <br />c? <br />s <br />O <br />Rush Analysis: 5 Days _ 2 Days_ 24hrs <br />Subject to surcharge <br />Q,A/QC report required: yes no <br />If yes, To: State Client Other <br />Lab number: 2 CIA 1Zl o —61 <br />Sample Temperature: Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />Relinquished by: &--- d &K L- f%e,gdel Date l ime .Received b Date ` i 72 <br />me <br />Relinquished by: Date mime Received by: Date Time <br />Relinquished by: Date Time Received by: Date Time <br />Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle®petallab.com * www.petallab.com <br />a <br />t <br />o F <br />z > <br />�,� <br />z <br />w <br />a <br />e <br />E g g <br />= <br />d <br />- <br />- <br />( )Ice Chest ( )UPS ()Fed Ex ( )Drop off <br />)Other <br />' . <br />Sample <br />Number Location Description <br />1Z ��� r n�� <br />• <br />Date <br />Sample <br />-�Z-ZZ <br />Time <br />Sample <br />�:�s <br />' ' A <br />2 <br />Relinquished by: &--- d &K L- f%e,gdel Date l ime .Received b Date ` i 72 <br />me <br />Relinquished by: Date mime Received by: Date Time <br />Relinquished by: Date Time Received by: Date Time <br />Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle®petallab.com * www.petallab.com <br />