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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS RE�'UES7' DC}f�'U1b1E11r",' <br /> ' ' 1 ' T INFORMAT10N <br /> Client: 6L!SL n/( —_ Sampler (s},_/l/E1L�l_ Hush Analysis: 5 Days__2 Days 291tra^ <br /> 1 Subject to surcharge <br /> Composite Sampler Setup: ( <br /> Customer Number: <br /> I Date: Time: _ A/ C re clrt re <br /> pp nn `'�- �i � � required: yes no <br /> — <br /> Address:_ . nU�C Subject to Surcharge Field Sampler: <br /> gIf yes,`ro: State Client Other <br /> is c � I Tette Milage; --, � _ <br /> , <br /> -� lab number: e t <br /> Phone SAMr <br /> IE CONDITION <br /> FAQ':_ � � �mx� M t Sample Temperature: Celsus I <br /> Project narltt?: _ ; o r ( ) Le,)king- { ) Broken. ( } VOA I-Ieadspace <br /> a <br /> x F•- f Custody Sea{ t ) yes ( ) no <br /> cY i = Ca z <br /> Contact person: N _ [ ' ii 3 rG 1 1:3 Do inr � • <br /> INFORMATION I I (-1Tce Chest { )UPS ( )lied lex ( ;f)rop off <br /> SAMPIE v `� ti R n )Otherainp P. <br /> � <br /> Nuctiebcr I LocationDescription Date 1 'Nine5 Q 3 3 x Z i • <br /> Sample Sara le <br /> Ir <br /> Itetinqui hedI 774Date ne Date <br /> ittre�' <br /> � j <br /> Received Uy: <br /> Ilelinquizhed by. — Date Titne --Received bv: Date _Titne <br /> 1?elinquished by: <br /> Date _Time the ceived by: Date 'Pixie <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 11 FAX: {209} 546-7,197 * Einail: jhNle1&peta11ab.com * www.pet.allab. am <br />