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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AATD at.A'ALYSIS REQUE-ST DOCUMENT <br /> CLIENT DETAILSREPORT INFORMATION <br /> Client:., Sampler- >ar �lCt (a�AHush Analysis: 5 Days___2 Days_ _?4hn; <br /> __ <br /> , . <br /> Composite Sampler et;up; Subject to surcharge <br /> Customer Number: --- <br /> Dat 3tc : I <br /> Time:..... Y,...- .- QA/QC report required: yes . no <br /> Subject to Surcharge. Field SaInpler. if yes,To: State_,. -. Client.,, _ Other <br /> .. Tictte l�Iilage:_ <br /> -_ _--._ Lab number 7 c) I <br /> �_. <br /> Phone: . <br /> Iwo- <br /> FAX: I � �� � � Sample Temperature: o <br /> Project name:_ ( ) Leaking. ( ) Broken. ( } VOA Iieadspace <br /> Custody Seal O yes ( } no <br /> Contact person: �° .sG� i l I law . II W11 w i <br /> 4• � � ( `f c� � F iL <br /> V' TNFORMA- rriON_LE SAM ( ( =' Y ( )lee Chest ( }UPS ( }Fed Ex )Drop offlather ! <br /> Date <br /> Tambo Sample Sample Sample a c <br /> LoCatlori�eSCrl t�otl _ MIs gym of=I <br /> -?-4rJa3E0_Aar- <br /> Relinquished by: Date*�il, iteceived by: Date_) affime <br /> Relinquished by: —Date .-___.__._Time ---.-- --Received by: - Date-._______.Time <br /> Relinquished b <br /> 4 5 -- -Date ______Tune by: �...�..,Date____Time <br /> 3935 N. Coronado Ave. " Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jh.vle@petallab.com *- www ---- <br /> Page 10 of 10 <br />