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PRECISION ENV'IRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS <br /> 0. REPORT INFORMATION <br /> Client: D, 10•'t P M v 2P Sampler(s): VA'I C_ { / Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: p M Date: Time: QA/QC report required: yes no <br /> Address: �3JA ZI _ Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> (,0 p I I �A ,may j Time Milage: Lab number: q O S 2Q <br /> ` 1 I <br /> Phone: ��� ?! "�6/3 • • <br /> � x <br /> FAX: (1,C1 33 GU7 Z3 33 <br /> _ Sample Temperature: <br /> Celsus <br /> Project name: �W Db��DrrG � v a s F° 0 = o O Leaking. O Broken. ( }VOA Headspace <br /> J Custody Seal( )yes ( )no <br /> Contact person: T?i _ g o m o m • ' • <br /> o <br /> INFORMsIce Chest ( )LIPS ( )Fed Ex (Drop off ( )Other <br /> SAMPLE E U 4 gro3 ei w <br /> • • fA <br /> Sample Date Time333 <br /> Number Location Description Sample Sample z w v3,v3 a a a • • ' A <br /> 5s73 �, 2 _ _ <br /> I' D 13 C PN <br /> CUSTODY <br /> Relinquished by: Date k11�Time �J Received by: Dates ZU Mime ' 2 <br /> w <br /> Relinquished b� Date Time Received by:--. Date Time <br /> (n Relinquished b Date Time Received b <br /> o q Y' Y Date Time <br /> r cn <br /> 1935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.coin * www.petallab.com <br />