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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: 1, I1 J1i ;"t M'1:'1f ph 11 <br />Customer Number: <br />Address: <br />Sampler (s): ;e3refAV YE'i/ d e,, l <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 Client Other <br />Lab number: 2 G r-' E - 12- Ci <br />Phone: 0 OWKIJ• <br />Sample Temperature: bVGG10jt ^ Celsus <br />�— <br />a w o v <br />A <br />L� r�Ic �it`i i`ck <br />() Leaking. Broken. VOA Headspace o <br />Project name: <br />Custody Seal () yes () no <br />Contact person: &GJ CIIGrYI d C3 a x M <br />96 0 <br />)Ice Chest ( )UPS ()Fed Ex ( )Drop off <br />SAMPUE • • o F Q $ )Other <br />1. <br />Sample Date Time ' ¢ a ° 3 L z <br />Location Description 0 <br />3fta <br />Number Sample Sample z > w Co c? P <br />L 1 1 r�_-1h l -3v (4 f;(� P <br />OD <br />Relinquished by"l Date ime Received ley: e------- Dat �J Z e Ll"rc " <br />Relinquished by: Date _� ime Received by:' Date Time <br />77Relinquished by: Date mime Received by: Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle®petallab.com * www.petallab.com <br />