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PRECISION I -TECH CHAIN �� C���®�� <br /> AND ANALYSIS REQUEST DOCUMENT <br /> t ' i.REPORTINF• ' ! <br /> Client: P, 3 Sampler(s): Rush Analysis: 5 Days _2 Days,24hrs <br /> n Composite Sampler etup; Subject to surcharge <br /> Customer Number: <br /> Date; Time: ! QA/QC report required: yes no <br /> Address: Subject to Surcharge Field Sampler: If yes,To: State Client _ Other f <br /> Time Milage: <br /> CA ,_ e 3 G `} � Lab number: 1.5 <br /> Phone: 2. Oq - S I- Cc/G 2 ! _ ! 79 ! <br /> '1> ' Sampeale Temperature: Celsus <br /> FAX: E KO�F _i, c k 1 �� T r, c.,l C C� f � � ' o <br /> Lea <br /> l' )Broken. ( )VOA Headspace <br /> Project name:_10( � Wc1iey ) �s-( 11C,; _ '�Q -3 4 o Custody Seal()yes ( )no ! <br /> v z TIM <br /> ! ! <br /> Contact person: 7ct'_<' Ro�'C� = s <br /> Rr -c a z c <br /> I " I j )Ice Chess ; )L-PS ( )Fed Ex ( )Drop off ( )Other <br /> Sample I DateI Time I =`� z' <br /> Location Description i ! -o I � • • Alet V D1 <br /> Number, Sample Sample ! z> <br /> f I <br /> i <br /> , <br /> f i _ <br /> 1 <br /> Relinquished h �r�+ C- Date-_1 7 Time %6,' -L-�4gr <br /> q y: Received by: -.r Date ime'J <br /> Relinquished bye %jr, 1'� tg Dated 1i{1 f t Time_No_received by ".;;� f rZ_Date 2�L�Timc <br /> Relinquished by: Date Time Received by:_ �J Date^ Time <br /> 3935 1`I. Coronado Ave. Stockton CA 95204 Telephone (209) 477-3105 FAX: (209) 546-7497 Email: jhvle@petallab.com tivww.petallab.com <br />