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PRECISION ENVIRO-TECH CHAIN OF CUSTODY r <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING J I REPORT INFORMATION <br /> G `1/ <br /> Sampler (s ' Rush Analysis: 5 Days ......'l <br /> Composite Sampler Set Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Ad . pn5j� Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> KapF- <br /> ss: Ph <br /> %0'1 r. qO0/ Time Milage: a6Lab number <br /> Phone: o2d�� dZ . /b �a2CONDITION <br /> a a Sample Temperature: � Celsus <br /> FAX: �; 3 <br /> x <br /> all o S ( ) Leaking. l ) Broken. ( ) VOA lleadspac v <br /> Project name. nNel PI Ll S CMUg2 d a R Custody Seal ( ) yes Ano <br /> o <br /> mTRANSPORTATION <br /> Contact person: <br /> a ( )Ice Chest ( )UPS ( )Fed Ex ( rop off <br /> SAMPEE INFORMATION s <br /> 3 <br /> )Other <br /> s <br /> Sample Location Description Date Time 1< <br /> Number Sample Sample � Z> m � � m <br /> z <br /> Relinquished by: Date� <br /> ime t77imef _ Receivddb Date3 � <br /> ime <br /> Relinquished by: Date -1 inie Received by: Date ime _ <br /> Relinquished by: _ Date ime .Received by: Date__Time _ <br /> 3935 N. Coronado Ave. Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle®petallab.coni * www.pet.allab.com <br />