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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORT"CLIENT DETAILS <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: "'�e '� Sampler(s): — <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: '`wt+t A Z Subject to Surcharge Field Sampler: If yes,To: State Client q Other <br /> t� Time Milage: Lab number: ' <br /> Phone: �2,o 33 ¢-64,0 • • <br /> 3 <br /> Sample Temperature: Celsus <br /> FAX: <br /> �.2 o o r <br /> z a o c z O <br /> ( )Leaking. ( )Broken. ( )VOA Headspace <br /> �Q g <br /> Project name: '" �'�` ° 2�ai a N Custody Seal O yes O no <br /> •�-' p G CQ 3 N cv <br /> il <br /> Contact person: o m m <br /> m °F z ��y z <br /> OIce Chest )UPS )Fed Ex Drop off ( )Other <br /> SAMPLE <br /> • • ° a <br /> • <br /> .o a � z <br /> Sample Date Time ° 9¢ a m x <br /> Number Location Description Sample Sample F z'° a. ��? aANAEYSES REQUESTED <br /> PA 14-7U'4 <br /> !ICUST11 <br /> Relinquished b :-�3 Date Time Received by: Dat�JJZJJ <br /> Relinquished by: Date Time Received by: Date Time <br /> 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 />