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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORTINFORMATION <br /> � ( ' ' Rush Analysis: 5 DaysD24hrs <br /> Client: 6AU�t+y— <br /> Sampler(s): 1 �7Days— <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: �, J - ��j`,n ZI Subject to Surcharge Field Sampler: If yes, To: State _Client _ Other <br /> —1 Time Milage: <br /> Lab number: <br /> Phone: 13 1 • <br /> _ m <br /> Temperature:Tem <br /> FAX: C�`1) .334- o.>z,; Sample� � 9� P P Celsus <br /> a v N C ()Leaking. ( )Broken. ( )VOA Headspace <br /> G>2Tv P.RSS m 1 o s <br /> Project name: F Custody Seal()yes ()no <br /> g e M N <br /> e m TRANSPORTATION <br /> Contact person: 6 ; ��l z a v Z o <br /> a 3 a q a ( Ice Chest ( )UPS ()Fed Ex (Drop off ( )Other <br /> SAMPLE INFORMATIONo <br /> Sample Date Time a g a a m A <br /> Number Location Description ample Sample F z'° g �v� y a ? `? REQUESTED <br /> �3bzn°u)•�+u�,9g�.,�ItrE �so !y h P <br /> I <br /> ICUSTODY <br /> i <br /> 77. <br /> �� .�� ,� � �� <br /> Relinquished by: Date it Time �2,(1 Received by: Dat&Time J`y-F <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:Peta1545@sbcglobal.net*we;w.petaUab.com <br />