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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Client: �.tyJTfJ / (� !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 (�[ + '�.�' (�tJ Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> TimeMilage: Q <br /> Lab number: <br /> Phone — OQ3 SAMPIE <br /> G CyJ <br /> S <br /> FAX: �" r-� �; y m 3 _ x Sample Temperature: Celsus <br /> oc <br /> F 3� ? z o <br /> Leaking. ()Broken. ( )VOA Headspace <br /> Project name: ��tIT m <br /> m <br /> 3 F Q c Custody Seal ()yes ()no <br /> .a C7 0 ,Zv.,0.Fvl q A N z <br /> Contact person: BWSAMPLE TRANSPORTATION <br /> � �F z yds b 0 o <br /> �a o d 333 z zz <br /> z ' <br /> „b „ v ( )Ice Chest ()UPS ()Fed Ex Drop off ()Other <br /> Sample Date Time c c� �' 3 , z <br /> Location Description 0 3 j3 x ■ <br /> NumberSample Sample z c?3 A <br /> rck <br /> C Q <br /> CUSTODY0 D10 V.11 11,111 4 <br /> Relinquished by: at imp Received by: Date 2 1 ime S Z <br /> m <br /> Relinquished by: Date Time Received by: Date Time <br /> v Relinquished by: Date Time Received by: Date Time <br /> 0 <br /> v <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />