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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS . REPORT . <br /> Rush Analysis: 5 Days _2 Days_24hre <br /> Client: �i�-n^� MJ"'i l Sampler(s): ��Te-tI — <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: P' 0 ' 3o4 24 r6 o Subject to Surcharge Field Sampler: If yes,To: State Client _Other <br /> C-4 4?S�" Time Milage: 9791L�-6 <br /> � Lab number: <br /> Phone: CZE%� 33¢-(oG l; SAMI­"EECON • <br /> s - x <br /> a <br /> FAX: (70-1) 3-3f-- 07Z-3 Sample Temperature-. <br /> cm/ Celsus <br /> ssV z` S <br /> ( )Leaking. O Broken. ( )VOA Headspace <br /> Project name: 1 " d a A g R q Custody Seal O yes O no <br /> Contact person: <br /> o S.Tuggcr• 9x°1//i /z: aue, ��go£F <br /> zJ` <br /> Ice Chest <br /> t UPS� Ped Ex <br /> • <br /> off ()Other SAMPLE herOroP• • a ` N <br /> Sample Location Description Date Time <br /> Number Sample Sample zs To <br /> VOLA-01%v a 1e4 30 Cr P fr4,10_ <br /> .s A/ bd3C� <br /> Relinquished b . Date L�JTime /7'"ro Received b ZZ <br /> y� Date / 7Time / <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@petahab.com * www.petallab.com <br />