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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> SAMPLINGCLIENT DETAILS REPORT • ' • <br /> Client: �-) L Sampler (s): &6MAOiJ 1J{ Rush Analysis: 5 Days_2 Days_24hrs_ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: H -(.,(,1:3 Date: b I 1 747L. Time: QA/QC report required: yes no <br /> Address: ?4/7 JJ C.LOJS/t PILL_ Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> Time Milage: Lab number: t <br /> Phone: SAMPLE CONDITION <br /> U <br /> a d Sample Temperature: Celsus <br /> FAX:_ .� q <br /> bo3 <br /> o <br /> zs s 0 <br /> ( ) Leaking. Broken. VOA Headspace <br /> Project name: L-4-i�� <br /> - Custody Seal ( ) yes ( ) no <br /> a FFG m <br /> .." N Z <br /> Contact person: 10 1,KL*.A&'/ d a x • • <br /> O M d Ep tl O <br /> a •�H <br /> • )Ice Chest { )UPS OWed Ex ( )Drop off <br /> )Other <br /> Sample Date Time d I a a w�� ' I K <br /> p <br /> Location Description a o zANALYSES A • <br /> Number Sample Sample P z> w c? a W <br /> Relinquished by: X Date ' ime .5, Received by: - Date ime <br /> Relinquished by: Date _Time Received by: Date- Time <br /> Relinquished by: Date ime Received by: Date Time <br /> L 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />