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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING _o <br /> REPORT INFORMATION <br /> m <br /> CD <br /> w <br /> "/ Rush Analysis:5 Days_2 Days_24hrs_ a <br /> Client:��5 EN 41�� 111J( lA e, Sampler (s <br /> Composite Sampler tup: Subject to surcharge <br /> Customer Number: Date: <br /> Time: QA/QC report required: yes no <br /> Address: F1 6 . $Oy- -27 14 Subject to Surcharge Field Sampler: If yes,To: State qq Client_ Other <br /> �SW e-K— 4A n!0� I Time Milage: Lab number: <br /> Phone: U Q— 4o7-' /64'o2- SAMPLE CONDITION <br /> v <br /> x <br /> Sample Temperature: 2 J Celsus <br /> FAX: <br /> L m C[G a x0 O <br /> n ' 1�v��� O��D e a Q o O Leaking. O Broke ( ) VOA Headspace <br /> Project name: C ry H Custody Seal ( > yes no <br /> 3 yy <br /> a �FeSAMPLE TRANSPORTATION <br /> N z <br /> Contactperson: c o <br /> , z° zz 9— z mmw <br /> e� 333 x <br /> a s ( )Ice Chest )UPS OWed Ex Drop off <br /> SAMPLE INFORMATION )Other <br /> ��_ °o <br /> Sample Date Time a a R s z <br /> Location Description 0 3 3 <br /> Number Sample Sample z <br /> 1 y 23 10 fj - g _ - <br /> S fI <br /> CUSTODY <br /> mapO Relinquished by: Date Z e d-im Received by: Date 1 ' Time IFF <br /> Relinquished by: Date ime Received by: Date Time <br /> Relinquished by: Date mime Received by: Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle®petallab.com * www.petaRab.com <br />