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I 12-0 g 2.Z -01 <br />Composite Sampler Setup: <br /> Subject to surcharge <br />Time: QA/QC report required: yes no <br />If yes, To: State Client Other <br />Lab number: <br />CLIENT DETAILS <br />Page 7 of 7 <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 Email: jhvle@petallab.com * WWW. <br />PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />Client: Ci...ie'LVE <br />Customer Number: <br />Address- g D1 37 T1 <br />tig Lacy-, , (A Y. C-3',/ <br />Phone: /- <br />FAX: <br />Project name. e.;i117705. <br />Contact person: De/ iv 44 .E ,V/ <br />SAMPLE INFORMATION <br /> <br />Sample 1 Date Time Location Description L. Number Sample <br /> <br />/ 1'575-5 All rei/044 Y7A L/040 <br /> <br />,1 &I,,'1/-L <br />Sample <br />Lice Chest ( )1:PS )Fed Ex (Drop off <br />)Other <br />ANALYSES REQUESTED <br />tvi 1 rgAfa <br />Relinquished by:. <br />Relinquished by: <br />I Relinquished by - <br />'112 Received 13.• <br />Date _____2irne __Received by: Date Time <br />Date Time _______Received by. Date Time <br />ime <br />z <br />1! , <br />4, I>54 <br />AND ANALYSIS REQUEST DOCUMENT <br />SAMPLING <br />z4 j 7 7 t.egr-4.4. <br />REPORT INFORMATION <br />Rush Analysis: 5 Days 2 Days 24hrs <br />SAMPLE CONDITION <br />Sample Temperature: Celsus <br />(i Leaking. ) Broken. ( ) VOA Headspace <br />Custody Seal yes no <br />SAMPLE TRANSPORTATION <br />Sampler (s: <br />Date: <br />Subject to Surcharge Field Sampler: <br />Time Milage: