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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMEA7 <br /> CLIENT DETAILS SAMPLINGREPORT INFORMATION <br /> Rush Analysis:5 Days_2 Days 2lhrs_ <br /> Client: ����j�s��—�A��L�� //V� //V Sampler is <br /> Composite Sampler Set <br /> Subject to surcharge <br /> Customer Number: Date: <br /> Time: QA/QC report required: yes no <br /> Address:F, aox 37q!� Subject to Surcharge Field Sampler: If yes,To:State_Client_ Other <br /> Time T Milage: Lab number: _ <br /> Phone:T,42--1f 6E, , SAMPEE CONDITION <br /> U <br /> FAX s �a M Sample Temperature: \,L_n, Celsus <br /> _ z <br /> �� o z ( )Leaking. ( ) Broken. ( )VOA Headspace <br /> Project name* C AEy N T V O c Custody Seal ( )yes ( )no <br /> Contact person: DDA/G�SA/F_✓ g s s o <br /> 3 3 3 3 3 ? ( )Ice Chest ( )UPS OFed Ex ( )Drop off <br /> SAMPLEa SF a 4£s w m ether <br /> !!� <br /> Sample Date Time � < aD f?j � z $ <br /> Number <br /> Location Description Sample Sample o REQUESTED <br /> z> 9 � �? ._^ W <br /> $ . 4o 49m s =3d <br /> -- <br /> CUSTODY <br /> �� <br /> F Relinquished by: Date s ime /o received by: Wnt—Date ime <br /> —.--�- Relinquished by: Date _mime Received by: Date Time <br /> Relinquished by: Date _Dime Rived by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />