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PRECISION ETNVIRO-r E CH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> DETAILSI 'CLIENT <br /> RIEPORT INFORMATION <br /> Client: 0A , V� �y ! Sampler(s): � ��.� I Rush Analysis: 5 Days _2 Days_24hrs— <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer 1`?umber:, Date: <br /> y� I Time: QA/QC report required: yes no <br /> Address: � O - y�'� � 90 I Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> C,4 . Q f Z q) Time Milage: Q G ) Q r <br /> Lab number: jf — 0� <br /> Phone: �'`+ 33 Y— GGI 5 <br /> 3 <br /> FAX 3Yt [ Sample Temperature: Celsus <br /> "wb ° o <br /> s z o <br /> Project name: LA&C>MA�-S1 N 0 � � A .C � � m ()Leaking. ()Broken. ( )VOA Headspace <br /> �, a A Custody Seal(}yes ()no <br /> t <br /> Contact person: Mu ( <<c 1 b'� = v V x • <br /> S � , : m o • <br /> F <br /> a ! o d z <br /> 12 1 W; F d b 3 a ! Ice Chest ()UPS ()Fed Ex <br /> • • o m , Drop off ( )Other <br /> o <br /> Sample t Date Time d A <br /> Number ��r��':��:�G R Descr*'P G:l: f a j 5¢ w 3 3 m x 2 i <br /> Sample Sample i z'° w w 0 �, c a m ! • <br /> I6b�2 Bs�- i /r� , �Z I !� (� D <br /> I D - <br /> ! <br /> EEE <br /> f 464 <br /> p Relinquished <br /> b--DateAime�Received y: Dat ev I� i e �a7 <br /> Su <br /> M Relinquished by: Date Time Received by: Dat Time <br /> v Relinquished b <br /> 0 4 Y Date Time Received by: Date Time <br /> LT v <br /> 935 N. Coronado Ave. Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />