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PRECISION ENVIRO—TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> MM <br /> �'��on at Sampler(s): 9,10610 ffG�/�Gl Rush Analysis: 5 Days _2 Days_24hrs_ <br /> M7 <br /> Client: an rn oti ___ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: <br /> Time: QA/QC report required: yes no <br /> Address: P.O. Q x Z110 Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> Lod; cc. a5 Time Milage: Lab number: L G L, <br /> Phone: (tDCA) 33q - w3 E5 SAMPLE CONDITION <br /> s - x <br /> d � <br /> FAX: m o a x Sample Temperature: )C. C Celsus <br /> z <br /> a 0. <br /> ( )Leaking. ( )Broken. ( )VOA Headspace <br /> Project name: 2 3 q Ncu, �� I�,'�or �u 6 a Custody Seal( )yes o <br /> FLI 0 <br /> Contact person: g�ad�LU li wil"Id d d� o M <br /> °� z s� z o <br /> OIce Chest )UPS OWed Ex rop oft' ( )Other <br /> SAMPLE INFORMATION <br /> ° o yC73 Z ���SSS o <br /> Sample Date Time g a a 3 �i <br /> Location Description °0 3 3 z ANALYSES <br /> • REQUESTED <br /> Number p Sample Sample z> a ?�?3 �? a m <br /> �C 1 2 G2 N q11 13 : t o P I�rc��,� ;C� <br /> 7 CUSTODY <br /> Relinquished by: 13(c d 10 YAYAI Date W3 Time 13 : 31— Received Date .lSGTime <br /> Relinquished by:— Date Time __Received by: Date Time <br /> Relinquished by: Date __Time_ Received by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvledpetallab.com * ww4 Page 6 of 11 <br />