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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEMST 90CUMEIN'T <br />Rush Anabsis-, 5 Days _ 2 Davis 24hrs <br />Sampler (a. <br />Client: ��H IE� N e if ON614 Ll i Al 7 <br />Composite Sampler Setup: Subdeet to surcharge <br />Customer Number: Date: / I& Igt —Time: QkVQC roport "uired. yeA — no <br />,tkddress: Subject to Surcharge Field Samplen If Nw, Tw State _ Client _ Other <br />Time lvlilage.— lAb number: I I I C) 11 0 <br />Phone: SAMPLE CONDITION <br />FAX: <br />Sample Temperature.-. Celsus <br />*m <br />v <br />Leaking, Broken. VOA Headspace <br />Projet-t name., Custody SeW yes no <br />rci <br />SAMPLE TRANSPORTATION <br />Contact person:_IMN t!WF4NV�/ 9 <br />lee Chest )UPS, )Fed Ex )Drop off <br />SAMPLE INFORMATION—Eder <br />Sample tion ate Dwe <br />I Location D"crip <br />Number Sample Sample <br />1 176 2 D W, 11RAI AI)ATIF-Al 11- 1, 0 6 44M P I DO I A/ t T9ATF_ Yw.-Az- Ai-kA"d, Tt <br />Relincluish-ed by� z Is <br />We *AT _&�CRec*ived bJr <br />Rdkstd by—Date _--nme bY,,' Date __—Time <br />777_ <br />ptlinquishedby= mto ____Tinw _—Yemived by, Date __—Til"Me <br />Page 7 of 7 <br />VA Qr;1"A Talanihnno, 1901,41 477-RI05 * FAX: (209) 546-7497 * Email. i1Fvle,6rw,,taIlab.com * www,PetaItR_Tc0m <br />