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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />51.64144(-0 Client: dif iE <br />AND ANALYSIS REQUEST DOCUMENT <br />REPORT INFORMATION <br />Rush Analysis: 5 Days 2 Days_ 24hrs__ <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yea, To: State Client ___ Other <br />Lab number: <br />Sample Temperature: soc_ Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />SAMPLE TI tANSPORTAT ION <br />( Ace Chest ( )UPS ( )Fed Ex ( )Drop off ( <br />)Other <br />-4027:41.4114gr iao .4144:14.4Als, AL-AS/44 1 <br />rirdeaaVtdr ..2144.4,4rd EASE, 0151,-04.- <br />rts,...eya, <br />Sample Location Description Number <br />SAM PILE INFORMATION <br />CLIENT DETAILS <br />Date Tune <br /> Sample Sample <br />---0110,42.r,SketTiNA44—TAA4t Atillif 4 _Wit <br />t. <br />HP:MAIMS <br />Relinquished by: <br />Relinquished by: <br />Relinquished by <br />Date ," . ime l2,. Tteeeived bp-I__ Date Tinte <br />Date Time _Received by: Date ...Time <br /> Date Time _______Received by: Date ___Time <br />Sampler (Si; <br />Composite Sampler etup: <br />Date: <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />Customer Number: <br />Address:j C Jia,x_3714 <br />Phone: 4:26%9_ 412_- <br />FAX: <br />Project name:_ergagAt...-2igefeseratel <br />Contact person: Z.>(.2A( (141,1544,:ry <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com wwwi -13 gk en 10 of 10 I