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Address 540 N EI Dorado Street, Stockton , CA Record ID SR0075895 <br /> Date : 1 -26-2017 Program : UST removal <br /> PHOTO 19 : <br /> Chain of custody for the collected samples <br /> PRECISION ENVIRO - TECH CHAIN OF CUSTODY <br /> ANDANALYSISREQUEST DOCUMEI T <br /> REPORT INFORMATION <br /> Client: I L fill eloc Sampler (s) : L Rush Analysis: 5 Days _ 2 Days _24hrs <br /> dP. Ctt ro ft � Ln <br /> I <br /> Composite Sampler Setup : Subject to surcharge <br /> Customer Number: � L Date: <br /> Time : QA/QC report required: yes no I <br /> O I <br /> Address : <br /> .Y:3 7 � h . Ka7A-U'� ' Subject to Surcharge Field Sampler: If yes , To: State _ Client _ Other <br /> c r k a L3 5� . i Time Milage: Lab number: <br /> Phone : T - j C� aCONDITION <br /> FAX: C Z B � � 464 _ � � E �• � - _ z Sample Temperature: Celsus <br /> o z <br /> z <br /> = ) Leaking. O Broken . ( ) VOA Headspace <br /> Project name : Custody Seal O es no <br /> (^ o 0 4! ° y <br /> a z <br /> Contact person: �AU' % I ( tCti r7t% Like <br /> i I a o • • <br /> F wM z syr z 0 <br /> s <br /> ORA <br /> • d z ° b s a ( )Ice Chest OliPS ( )Fed Ex ( )Drop off l : Other <br /> ° F o y V <br /> .. s rq' U � =SampleC, a I <br /> Number Location Description Date Time G � � � z <br /> P . <br /> ample Sample F' z > <br /> ! Z <br /> MTS <br /> ' V .. � rr7rf7 <br /> 11 <br /> I <br /> Relinquished hy: Date Time Received by: Date <br /> rime <br /> Relinquished by: Date I Time Received by : Date .. Time <br /> Relinquished by: Date Time Received by: Date <br /> Time <br /> 3935 N. Coronado Ave . 7 <br /> Stockton CA 95204 * Telephone ( 209) 477- 8105 FAX: ( 209) 546- 7497 * Email : jhvleftetallab . coru `" wlrw .petallab . coin <br /> Elena Manzo , REHS Page 19 of 21 <br />