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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING <br /> INFORMATION <br /> Client: BJH APE- 17r30.-.�CLa?UZA�.O Sampler(s): 1 0 Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: � � Date: <br /> Time: QA/QC report required: yes no <br /> Address:.I lot y1 _ C)f-c-ma qv_-w f Subject to Surcharge Field Sampler: If yes, To: State II Client Other <br /> 50 � <br /> ` CSI✓" n 1 _ S'LO(40 Time Milage: Lab number: 1 I 0 G <br /> Phone: 2-%Z 'l— Z� J cJQ C)9 '3SAMPLE CONDITION <br /> FAX: TM1 NAV-- J__S}.tWeGkL_ CA 6 ro m c 3 x Sample Temperature: Celsus <br /> w yw r z o <br /> Project name: p 12�'`'��• b m O Leaking. O Broken. ( )VOA Headspace <br /> F A a o Custody Seal O yes O no <br /> y �A A N z <br /> Contact person: (M I A 1 L5P F a x <br /> m 0 <br /> )IceChest ()UPS ( )Fed Ex Drop off ( )Other <br /> SAdWPIE,E INIFORAIATION <br /> Sample Date Time d a N z <br /> Location Description a =0 3 3 x • A <br /> Number S ple Sample H z> w v c? w PCs <br /> 1 M ET,4 l_ 5 4AVIiJ( Ills 1-200 <br /> �A W D fA?kTFp k t► IS 17,10 S CA Wl- <br /> REMARKS I- C11 OVA <br /> 11 Relinquished by: e e16�q_S Received _ ate 1 �me Ov; `r <br /> Q Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> 393 N. Coronado—Ave. Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br /> GH/�E <br />