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PRECISION ENVIRO - TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETMLS NORMS <br /> REPORT OR <br /> Client: AY, " A t 1'�o M-t to Sampler (s) '� v Rush Analysis: S Days _ 2 Days _24hrs _ <br /> Composite Sampler Setup : Subject to surcharge <br /> Customer Number : L Date : <br /> p Time : QA/QC report required : yes no <br /> Address : 1 AU Subject to Surcharge Field Sampler: If yes , To: State Client Other <br /> <'T- L< I Time Wage: <br /> Lab number : <br /> Phone : SAMPLE CONIDITION <br /> U <br /> FAX : ��� _ C�, a _ Sample Temperature : Celsus <br /> " Y <br /> � p o o s <br /> s ; _ c ) Leaking. ( ) Broken. ( ) VOA Headspace <br /> Project name : U ' <br /> C ° Custody Seal ( ) yes ( ) no <br /> iiiiiiii NEVER 4 1111 pill 111111gilill 11111111 <br /> F Q <br /> > <br /> Contact person: t6� 1`wci <br /> o <br /> = z ty � z c <br /> 4 <br /> z G v ( )Ice Chest ( )tTPS ( )Fed Ex ( )Drop off ( )Other <br /> SAMPLE INIFORA/11ATION <br /> Sam le <br /> p Location Dese tion Date Time a 0 3 3 , z <br /> Number p ample Sample z > f m' ANALYSES REALTESTED <br /> T/7 ne � � �� �CUSTODY ' <br /> zdz <br /> TI <br /> v <br /> ; Relinquished by: Date Time d A M eceived by: . DateI�fih Time <br /> � t'f _ <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> 3935 N .ronado Ave. *J Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546- 7497 * Email : jhvle@petallab. com * www. petallab . com <br />