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PRECISION ENTVIRO-T`E C:I-I C:N:Al?4 OF CU�rco.r�5r <br /> AND ANALYSIS REQUEST DOCUMENT <br /> Client: i� 'v. Sampler(s): Nl 44< ! I Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: D <br /> _uu Date: <br /> Time: QA/QC report required: ,yes no <br /> Address: F, J ' i3-:,X Zi %V Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> Time 1VIilage: <br /> —,( � ` I r 24l Lab number: ��/ �t q t � -O <br /> —`"=Y I <br /> Phone:� -3 3 V- G6 t''> _ T- <br /> +7 ✓ Y M <br /> FAX: 7 3 y - v.7 Z ,� o o Sample Temperature: Celsus <br /> a 0. C: p' <br /> 6. <br /> I n�L� �u - M b N m ( }Leaking. ( )Broken. ( )VOA Headspace <br /> i Project name:---/ _ J _ . <br /> I v G z n Custody Seal( ,)yes { )no <br /> Contact person: ��Ct ' �� _ x • <br /> s '� � a z <br /> s <br /> z M <br /> x '\ <br /> MOMM M4 <br /> i z `(.kIce Chest OUTS )Fed Ex )Drop off' ( )Other <br /> I Sample - C.0 <br /> P Date Time a <br /> Number Loesti.on Joescr.it-)o7on - <br /> Sample Sample v • • A <br /> A,4-reAtc-4.L_ e /i SP <br /> 6�✓G r~`l 7i C �`1 B C <br /> 1pG <br /> I <br /> Relinquished by: Uat �����jime_I Z y Received b F �Q <br /> y Date MTime <br /> Relinquished by: Date Tim© Received by: Date Time <br /> cn <br /> p Relinquished by: Date Time Received by: Date Time <br /> v, <br /> 935 N. Coronado Ave. " Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />