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PRECISION ENVIRO-TECH CHArN OF CUSTODY <br />CLIENT DETAILS & I AND ANALYSIS REQUEST DOCUMENT <br />INFORMATIONMREPORT <br />Client, Sampler(s): kl!!T%%'V ftnsh Analysis: 5 Days _ 2 Days_24hrs <br />Customer I\Tumber: J ry� <br />Address: & 7 k <br />Phone: LZ_ <br />FAX: <br />Project name:_ ��� o � IFP 17-;F �! <br />Contact person: 7�S'I'�ii 1) -1 <br />Sample I Date Time <br />Number I Location Description IC ,1 0..__1 <br />REMARKS <br />Relinquished by: <br />Relinquished by: <br />Relinquished by: <br />w� <br />Composite Sampler Setup: Subject to surcharge <br />Date: Time: <br />QA/QC report required: yes no <br />Subject to Surcharge Field Sampler: I£ yes, To: State Client <br />,y, _ Other <br />Lab number <br />Time Milage: 1I x e1 C5__ B 1 <br />s - • • <br />m 7Sampl;eTemperature: <br />y o sCelsus <br />olc s N o <br />_ g. () Broken. ( ) VOA Headspace <br />3 q Custody Seal () yes () no <br />V G � <br />m Q z as z` c <br />zv 3E F s ( )Ice Chest ( )UPS ( )Fed Ex KDrOPoff ( )Other <br />ted <br />m z <br />Datef&u Time 110'C) Received by <br />Date Time Received by: <br />Date Time Received by: <br />Date10-7 Time �cs <br />Date Time <br />Date Time <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle©petallab.com * <br />wwJ Page 7 of 7 <br />