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PRECISION ENVIRO-TECH <br />CVxpyAc '.re,Vt-Rush Analysis: 5 Days 2 Days 24hrsSampler (s):_Client: <br />Subject to surcharge <br />Customer Number: Date:QA/QC report required: yes no <br />If yes, To: State Client Other <br />Lab number: <br />Sample Temperature:Celsus <br />Project name: <br />Contact person: <br />( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off ( )Other <br />a A <br />iv qA <br />3935 N. Coronado Ave.Telephone (209) 477-8105 Page 7 of 7* <br />CLIENT DETAILS SAMPLING REPORT INFORMATION <br />SAMPLE CONDITION <br />SAMPLE TRANSPORTATION <br />SAMPLE INFORMATION <br />ANALYSES REQUESTED <br />REMARKS CUSTODY A <br />Time <br />.Time <br />—Time <br />_Time <br />Date <br />Datc_ <br />Location DescriptionSample <br />Number <br />Date <br />Sample <br />Time <br />Sample <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Composite Sampler Setup: <br /> Time: <br />5 <br />! <br />I <br />1 <br />£ <br />s <br />I <br />s <br />1 <br />i <br />I <br />I <br />§ <br />i <br />£ <br />I <br />3 <br />5 <br />9 <br />1 <br />I <br />I <br />I <br />3 <br />Email: jhvle@petallab.com wwvl <br /> Relinquished by.^^ <br />Relinquished by: <br />Relinquished by:_ <br />9 <br />I <br />9 <br />! <br />J <br />■o <br />U2 <br />() Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />Dale ime. <br />Date <br />Date <br />FAX: (VfiXAg- Q. CbfYA <br />10 <br />yi <br />£ <br />1 <br />g <br />1 <br />e <br />li <br />11 <br />Address: <br />Phone: <br />Date ^1^6 Time <br />i ! <br />sp Jas <br />111 <br />le! <br />* Stockton CA 95204 * <br />C.-'*' ’ <br />* FAX: (209) 546-7497 * <br />Received by: <br />Received by: <br />Received by: <br />I -g_