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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />Client: 067-(4r11;a' <br />Customer Number: <br />Address: �CQur JL <br />0/4 <br />Phone: -- <br />FAX: <br />Project name: c t <br />Contact person: Jcad-l':�- l�f <br />mber Location Description Date Time <br />Saple <br />du <br />- S$anple I Samnl <br />REMARKS <br />Relinquished <br />Relinquished(by <br />Relinquished by <br />AND A-VALYSIS REQUEST DOCUMENT <br />lum <br />PORT IN] PAORAIATION <br />Sampler (s): ? A//tIf II, Rush Analysis: 5 Days _ 2 Days _24hrs <br />�ompof ite Sampler Setup: , n Subject to surcharge <br />Date: VI Z-9 17?- Time: QA/QC report required: yes _ no <br />Subject to Surcharge Field Sampler: If yes, To:�_ Client1 Other <br />Time llilage: C"�6p,/}�I <br />Lab number: 7 <br />Sample Temperature: 7/L Celsus <br />i Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal yes Ono <br />Dace /dime! 'Vf ��Reeceived <br />Date 7ime U''l Ceived by -..Date Time Received by: <br />ce Chest !. )UPS ( )Fed Ex ( )Drop ofd' ( )Other <br />7am5dow"M <br />:P , TS <br />Time <br />Datej4Time q[ <br />Date Time <br />3935 N_ Coronado Ave. a: Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />L <br />� <br />�- <br />"' <br />gym=` <br />z <br />- <br />� <br />Y1 <br />L <br />FFG <br />N <br />o <br />i <br />L <br />0 <br />r <br />63 <br />�F <br />C2 <br />F <br />F <br />z> <br />^. <br />P <br />F <br />ivy <br />X <br />Sample Temperature: 7/L Celsus <br />i Leaking. ( ) Broken. ( ) VOA Headspace <br />Custody Seal yes Ono <br />Dace /dime! 'Vf ��Reeceived <br />Date 7ime U''l Ceived by -..Date Time Received by: <br />ce Chest !. )UPS ( )Fed Ex ( )Drop ofd' ( )Other <br />7am5dow"M <br />:P , TS <br />Time <br />Datej4Time q[ <br />Date Time <br />3935 N_ Coronado Ave. a: Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />