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PRECISION E NVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQ VEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING <br /> Client: Sampler(s): r Rush Analysis: 5 Days _2 Days_24hrs <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: 1 Date: Time: QA/QC report required: yes no <br /> Address: �L��� I VL Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> Sjy r� f� �� /jd �9 Time Milage: Lab number: Q o <br /> Phone:669) -- U / <br /> S - x <br /> / 2 y <br /> FAX: c (�J �; x Sample Temperature: Celsus <br /> G <br /> A <br /> �x� <br /> C' <br /> `l Leaking. ()Broken. ( )VOA Headspace <br /> Project name: C' " - Q- ° Custody Seal()yes ()no <br /> G •• y W .�. x tp ♦ ■ ■ ■ F A <br /> Contact person: r�' XPi I• o F m o <br /> x <br /> )Ice Chest ()UPS ()Fed Ex XDrop off ( )Other <br /> SAMPILE INFORAIIATION <br /> 0 o <br /> Sample Date Time <br /> Number Location Description 0 3 j x <br /> Sample Sample z c�3 m ' J ftW3 DFZ ■ OUDID <br /> 64410'_/ U 1S:033c, — — S — - Di es'e <br /> T <br /> 1 <br /> .3DIJiftl. <br /> 11 CUSTODY1 <br /> Relinquished by: jFF Date fw Received by: Date 2�Time C <br /> CD Relinquished by: Date Time Received by: Date Time <br /> N Relinquished by: Date Time Received 5y: Date Time <br /> !`r3935 <br /> N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />