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_171RECTSTON ENVIRO-TECH C14-AIN OF CUSTODY <br /> AN_D ANALYSIS REQUEST DOC UIIIENT <br /> Client: V ►�- i� �h��j1S! L Cc7, Jh/�s Sampler(s):A4t ' Rush Analysis: 5 Days ?Days_24lirs_ <br /> f <br /> Composite Sampler Setup: Subject to surcharge. <br /> Customer Number: G Date: <br /> Time: QA/QC report required: yes no <br /> Address: ltM 1^401VSIM_Of Z Cre Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> 5EWkelb14,... Gzk '7215`?_vL Time Milage: Lab number: a()'_V)9 01 ^ Q 1--0 <br /> Phone:&q 2 3 — Z ?e1b ®� ® • <br /> MENEM <br /> FAX: �2�r� Z 3c{— 2�// �' _ c - Sample Temperature: Celsus <br /> Leaking. ()Broken. ( )VOA Headspace <br /> Project mole:—_fWt=7s <br /> n Custody Seal [)yes (}no <br /> Tl <br /> Contact person: tcej!g7 .f V - _ v G • s ■ • s ■ + <br /> n ■ • ? _ '- _ ( )Ice Chest ( )UPS ( )Fed Es rop ofd ( )Other <br /> `�7 - = - 7 _ <br /> Sam leI = - - '- _ <br /> Lz <br /> ?dumber <br /> Location Description Date Time _� _ � <br /> Sa ple I Sample <br /> c Am 1�1 <br /> I P <br /> 1 1 H <br /> i <br /> I <br /> i <br /> ee <br /> Relinquished by: Date im 3teccived by: Date J9Time <br /> tQ 77 Relinquished by late Time Received by Drake Time <br /> N <br /> V Relinquished by: Date Time Received by: Date Time <br /> 0 <br /> M1935 <br /> N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 548-7497 * Email: jhvle®petallab.com * w-ww.petallab.com <br />