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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: GL.a,.( '3 Nt�.n-Pj <br />Customer Number: La el ) - &&0 <br />Address: 81117 1J. C L vi=i= 1+A- <br />tCj,) � g!5 2-14 <br />Phone: (ZM) -)34-6615 -TH-a-ptl� <br />FAX: <br />Sampler (s): L101:11� pb to &j <br />Composite Sampler Setup: <br />Date: b' 1 7 4Zz— Time: Gl `, Z U <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />Project name: Wfu tiaih� <br />Contact person: <br />m <br />Sample Location Description tion Date <br />Number Sampl <br />.a <br />Time ° <br />Sample <br />-W-P F1--( . F- -I-- <br />Project <br />+1 <br />Rush Analysis: 5 Days 2 Days— 24hrs_ <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: Staten Client Other <br />Lab number: <br />Sample Temperature: Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />( )Ice Chest ( )UPS ( Fed Ex ( )Drop off <br />)Other <br />Relinquished by: Date till Time 51 Received by: Dateime <br />Relinquished by: Date mime Received by: Date Time <br />Relinquished 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 />U <br />oA <br />o <br />z <br />°0 <br />' <br />O <br />C7 <br />F G] <br />a <br />ie <br />00z <br />9E' <br />z <br />m 9' <br />,pgr <br />o <br />z <br />x <br />z� <br />Rush Analysis: 5 Days 2 Days— 24hrs_ <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: Staten Client Other <br />Lab number: <br />Sample Temperature: Celsus <br />( ) Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />( )Ice Chest ( )UPS ( Fed Ex ( )Drop off <br />)Other <br />Relinquished by: Date till Time 51 Received by: Dateime <br />Relinquished by: Date mime Received by: Date Time <br />Relinquished 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 />