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PRECISION ENVIRO-TECH DHAIN OFMQUCUSTODY <br /> , n�LLJ Sampler s - `� CUMNT <br /> 711alysis; 6 Daps T 2 Days_24hrs <br /> a7Chent:7[)("'0— ` � ), k <br /> Composite Sampler Setup: Subject to aurcherge <br /> Customer Number: D _M Date: Time: QAIQC report required: yes no <br /> Address: f p.a ' 00K L!Zo Subject to Surcharge Field Sampler: If yes,To:State Cfient Other <br /> _ l ir317 it CA �]�� 71me Lala number: <br /> 01.21 <br /> LOU Phone: - <br /> g ` Sample Temperature: Celsus <br /> z FAX. 3,f 07 i3 F a � p em P <br /> q <br /> m x <br /> '-`' i z ()Leaking.()Broken.{ )%1OA Headspace <br /> o Project name: SCf�ti-U^1 4 g Custody Seat-()Yes Ono <br /> H d 5 <br /> Fu. m <br /> Contact person: M(i`_7ul <br /> CL <br /> WIce Chest ()UPS ()Fed Ex XDrnp off ( ;Other <br /> to <br /> saaspte Rate 1 ime w B z <br /> Number' Location Description Sample samzie '01 ANAf,YSV REQ UE ST <br /> on <br /> L <br /> En <br /> U, <br /> m . <br /> 7Rehed : 3atef o-i♦?rl Time i. &csived Date ,,T`�Me r�� <br /> Noi : Date Tine Received by. Date Time <br /> m : Date Time Received by, Date Time <br /> 3936 N.Coronado Ave.*Stockton CA 95204 Telephone(209)477-8106*FAX{209)646-7497*Emag:Petal546@sbegiabal.net*www.petwIab.com <br /> L� L. L:m. Lz: L;_..: L.. _ L_ L� L„-.: L. L . L .. L� I— <br /> = <br />