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PR,E CI SI ON ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSISREQUEST DOCUMENT <br /> m <br /> w Sampler(s): I � 7Rushs:5Daps 2Days24hrsIL Client: �(LLUn( MU =P Composite Sampler Setup: ubject to surcharge <br /> Cu,-tomer Number: b M Dae; <br /> 7irite: QAlQC report required: yes ma <br /> Address: P0 ' 133;< Zi 00 Subject.to SurcliargeField Sampler: If yes,n: State Client other <br /> Time hUlage: M 0 0 G l 0 - 01 <br /> G4 ��Z�-( Lab number: . <br /> ?.0 33 �+3 <br /> Phone:.— 1 ! <br /> o <br /> FAX: �?.vi} 534_—u7�i �; o Sample Temperature: Celsus <br /> z 6 0 6 0 <br /> w s ()Leeking.()Broken.( )VOA Headspace <br /> o Project name: 1A)M'N 6` o U m CUE1to3y SeaJ'()yes Ono <br /> MI(GE Tb� a xSAMPLE TRANS1110111WriON <br /> Contact person: °N o <br /> a <br /> ;:7 11ceChest ( }UPS ()Fed Ex Drop off ()Other <br /> a <br /> _ y <br /> �; a <br /> Sample Date Time Y x <br /> Number ANALYSES REQUESTED <br /> Location Description ganple Sample z� V w & <br /> iz=ita ., _ <br /> Zn <br /> m <br /> co <br /> m <br /> �� <br /> m Relinquished by: Date 6/1' Time received by: Date In <br /> C14 gal-, <br /> Relinquished ay: Date Time deceived by: Date Time <br /> m Relinqushed by: Date Time Received by: Date Time <br /> 3935 N.Coronado Ave-*Stock,on CA 95204*Telephone(209)477-8105;t-FAX:(209,546-7497*Email:Petai545@sbcg'-obal.uet*www.petauab.com <br /> L_ C-.: L:_ L_: L:..:�' L-1 L.._ 4:.,_. <br />