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PRECISION E RQ-TECH CHAIN of CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INTORMATION <br /> i <br /> Client: VA'U- F- j -PAOC S //7c Sampler(s): r/814 4-' # t L- Rush Analysis:5 Days _2 Days_24hrs_ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: lip <br /> Date: Time: QA/QC report required:. yes_ no <br /> c2`. ii7/),/AF77 z J)12J1� Subjectto.Surcharge.FieldSamplei: If - <br /> Address: yes,To: State—Client _Other_ <br /> \, iC L��� CA Time Milage: '1(3,2q 0 Q ^ <br /> . Lab number: <br /> Phone: 12 � 9,93 - SAMPLE CON-DITION <br /> FAX: � T� � q43 _ p � Sample Temperature: Celsus <br /> PP)A)}2E�XArJFAfr—RX, : a ( Leaking. ()Broken_ VOA Headspace <br /> Project name: <br /> Custody Seal()yes ()no <br /> s M z <br /> Contact person: m <br /> z y z_ o <br /> X33 j)Ice Chest ()UPS ()Fed Ex ()Drop off ()Other <br /> SAMPLE INFORMATION <br /> Sample Date Time n, w z' 1 <br /> Number <br /> Location Description Sample Sample F z a vi m �, _ <br /> a� 5t L E� jfJ� k7 /v!)o IP m0-, <br /> CUSTODY <br /> Relinquished by. Dater'1" Time "PAIN Received by: Dat vime <br /> N <br /> D Relinquished- Date_Time Received by:. Date Time <br /> m <br /> M Relinquished by: Date_Time - Received by: Date Time <br /> 0 <br /> m <br /> 935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab:com * www.petallab.com <br />