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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS ' 'O ' O ' • <br /> AA r k Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: ��u�'.1 MV,G{�F+7 Sampler(s): �� — <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: D Date: <br /> Time: QA/QC report required: yes no <br /> Address: P O Z1 80 Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> CA 1) Time <br /> Lab number: � <br /> Time Milage: �—j i Q 9 1 d — Q I <br /> � �" � <br /> Phone: C � X74- 13SAMPLE CONDITION <br /> � M <br /> FAX: Sample Temperature: Celsus <br /> w r ° <br /> .� ! o N M O Leaking. O Broken. ( )VOA Headspace <br /> Project name: 1 P`�' �' <br /> J � � 3�3 �, � � Custody Seal O yes O no <br /> a o SFA A N z <br /> S �� o. o S . . . . • <br /> Contact person: K �°`'� • • <br /> s m M <br /> plf_k At-L) rev,^?ff-C. C ti 6 H z s z °z <br /> V <br /> 9 a 33' <br /> G Ice Chest ( )UPS ( )Fed Ex lDrop off ()Other <br /> a <br /> o ��3 zSAMPLE INFORMATION o <br /> Sample Da Time a a¢ a 33 x z <br /> Number ocation Description Sa Sample F z'° a. c?3 m a ' • REQUESTED <br /> V1, <br /> 6-r a w''L(_ <br /> 2 <br /> iv <br /> AvG <br /> 11 <br /> Relinquished b Date 7 �� Le 4 � Received by: Date ime <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: jhvleQpetallab.com * www.petallab.com <br />