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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSISREQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT , . , <br /> Rush Analysis: 5 Days _2 Days_24hrs <br /> (i <br /> Client: Dl <<On o v -P�l Sampler(s): Mayo — <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: C report <br /> QA/Q p required: yes. no <br /> Address: P, O' 3O X Z)(2,0 Subject to Surcharge Field Sampler: If yes,To: State Client _ Other <br /> 9)2.41 Time Mdage: Lab number: g O Z Z.) - <br /> Phone: CZ'°q) ;jrq_6p&(3SAMPLE CONDIT10N <br /> ��vk� j� o7Z? mea _ z Sample Temperature: Celsus <br /> FAX: t{ m a n <br /> cEi d g a O Leaking. O Broken.( )VOA Headspace <br /> Project name: w°r `�^ 3 g F $ Custody Seal O yes O no <br /> S v ;e3o N <br /> D i3 <br /> v z" <br /> to ILI= <br /> Contact person: <br /> m �� z° <br /> E g oa D a VIce Chest ( )UPS ( )FedEx 4)Drop off ( )Other <br /> SampleLocation Description nate Tame t .R z <br /> Number p Sample Sample E' z� � NOR • • • A (1 <br /> 1 w u N�«�a a)i�gN•,nA�� �. �Jz lir lz:�� CT '" DW <br /> ,¢txmp� <br /> I <br /> Ig ` <br /> Relinquished by: Date vio Time t 73 Received by: Date O T fine a .1 <br /> Relinquished by: Date _Time Received by: Date Time <br /> 777 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: jhvle@petallab.com * www.petallab.com <br />