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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Client: �.tyJTf� /,Q (� !j �f'� Sampler(s): �� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> ^''`►'-` Composite Sampler Setup: Subject to surcharge <br /> Customer Number: � Date: <br /> ► 2, Time: QA/QC report required: yes no <br /> Address:13 (�[ + '�.t' (�tJ Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> TimeQ d 2ill0 - <br /> Milage: <br /> Lab number: <br /> Phone — ';00-3 SAMPILE CONDITION <br /> FAX: r �s y c Sample Temperature: Celsus <br /> m=3 _ x c <br /> O ()Leaking. ()Broken. ( )VOA Headspace <br /> Project name: <br /> m <br /> c Custody Seal ()yes ()no <br /> .a C7 0 ,Zv.,0.Fvl q A N z <br /> SAMPLE TRANSPORTATION <br /> Contact person: <br /> � �F z yds b 0 o <br /> zz <br /> z 333 z ' <br /> ( )Ice Chest ()IMS ()Fed Ex Drop off ()Other <br /> SAMPLE INIFORMATION <br /> Sample Date z <br /> Location Description <br /> 0 3 j3 x ■ <br /> Number p Sample Sample z c?3REQUESTED <br /> Cx <br /> rck <br /> Ty IA- C Q <br /> CUSTODYFf� <br /> 0 IA W0 V.111 11,11i I <br /> -0Relinquished hy; , Dat imp Received by: Date 2 ime S Z <br /> CD Relinquished by: Date Time Received by: Date Time <br /> Iv Relinquished by: Date Time Received by: Date Time <br /> 0 <br /> N 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />