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PRECISION ENV1R0— _1_4',C7--T CHAIN OF CUSTODY <br /> t1NDANALYSIS REQUEST DOCUMENT <br /> ON <br /> Client: p i u-n h1 !'�t V�4Y i Sampler(s): , `( Rush Analysis: 5 Days _2 Days_24hrs <br /> i <br /> Customer Number: <br /> Composite Sampler Setup: Subject to surchnxge <br /> � M <br /> Date: Time: <br /> QA/QC report required: yes no <br /> Address: P- D �j�X � 80 Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> Time Milage: <br /> ��f ������ Lab number: <br /> Phone: �� 3'3�—.r•�13 • t • <br /> s x <br /> Fes : Sample Temper.ature: Celsus <br /> m O O y <br /> z o <br /> Project name: �� � F[ ()Leaking. ()Broken. ( )VOA Headspace <br /> 2 Custody Seal( )yes ()no <br /> Contact person: o i • • <br /> � ! 2 z o � <br /> Chest ()LJPS ( )Fed Ex i trop off ( )Other <br /> SAMPUE w of :c w F m v <br /> m I �C73 m W F <br /> Samplei Date } Time v w s N o <br /> Number I�OC''I"Jo1. De3Ct'TtY?;!fie . ; ;o X13 x z <br /> Sample ; F z y w •r.��� U � � • -NollA <br /> w <br /> t �w6u- 953 '1 b lc 1130 I �, t� P V f 3 u t;� <br /> r Go <br /> iCUST <br /> 1 <br /> ^ <br /> OD <br /> Relinquished Date 6 X 61"Time , ��1 Received Date Time i2:1-,5 <br /> Relinquished by: Date Time Received by: Date Time <br /> J Relinquished by: Date Time Received by: Date Time <br /> f <br /> LP <br /> J <br /> 935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />