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7—1 �:_} ) ,tel 7--) 7-1 71 77) ,''""1 ;"-1 ,"'�.1 7—_1. <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS WY.Akyj I U 19 10 1 REPORTINFORMATION <br /> Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: P Imor-i ' 1� 4u)"-V PWY Sampler(s): <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: P- O' 1-�-)X Zig Y)v Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> L"o); r CA q 2-4 t Time Milage: Lab number: 1 O b O <br /> Phone:�7•u�t� 33¢- �6 t 3 I • <br /> U <br /> FAX: <br /> (1,A) 3 34 -0°7 L3 3 Sample Temperature: Celsus <br /> �' <br /> m�3 x <br /> m ° v ()Leaking. { )Broken. ( }VOA Headspace <br /> 1�1 t�l�.0 M U A <br /> Project name: s d 3 Custody Seal()yes {}no <br /> iF❑ A � <br /> 8 0 E z <br /> Contact person: <br /> P SAMPLE • • , ' <br /> z o <br /> w m A Ice Chest ( )UPS ( )Fed Ex �Drop off ()Other <br /> SAMPLE INFORMATION <br /> d� d <br /> Sample Location Description Date Time d o o m m • <br /> Number Sample Sample z a <br /> 2 ' <br /> I <br /> CUSTODY <br /> i <br /> E <br /> i <br /> r <br /> v <br /> t <br /> I <br /> E <br /> f <br /> Relinquished Date �J'Time r Received by: Date 2,1 ' 20 <br /> Relinquished by: Date Time Received by: Date Time <br /> I <br /> i 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:Peta1545®sbcglobal.net*www.petallab.com <br />