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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS i <br /> • ' • <br /> Sampler(s7_1� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: i U":" r M V t Fc� Y p o ,omposeampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: <br /> U . ?j A Z � g p a Field Sampler:Subject to Surcharge If yes,To: State Client Other <br /> � < < � ` <br /> Time� Milage: L� V w Lab number: <br /> Phone: -1 3 -�6 13 • • <br /> s � x <br /> 3 <br /> FAX: � �' ?� >¢, Z m a _ x Sample Temperature: Celsus <br /> w ohm ° o <br /> o z <br /> c� o N <br /> ( )Leaking. ( )Broken. ( )VOA Headspace <br /> s y.0 ., m <br /> Project name: ���� " 0 F Q a ° Custody Seal O yes Ono <br /> p fi N <br /> N <br /> •o c? � ..F <br /> j <br /> yvl i T> � e v a x ' TRANSPORTATION <br /> Contact person: r F z y o <br /> z u ()Ice Chest ()UPS (Fed Ex A)Drop off ()Other <br /> SAMPLE • • <br /> o v o �,�3 +- c o <br /> Sample Date Time v ¢ a d x z <br /> Location Description =0 a- A <br /> Number Sample Sample z> is c? � a � • <br /> F.4vCcr 'r' r 0� <br /> Relinquished by: Date Time Received by: r i d +r? DatelLUAZime ; <br /> Relinquished by: Date Time Received by: 1 Date Time <br /> 7777Relinquished <br /> by: Date Time Received by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-5105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />