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PRECISION ENVIRO-TECH <br />Client: Rush Analysis: 5 Days 2 Days 24hrs <br />Subject to surcharge <br />Customer Number: Date:no <br />Lab number: <br />Phone: <br />FAX: CoGVkq \Sample Temperature:A <br />Project name: <br />Contact person: <br />( )Ice Chest ( )UPS ()Fed Ex ( )Drop off ()Other <br />£ c Col; <br />A <br />Date 'ime <br />Page 7 of 7 <br />CLIENT DETAILS SAMPLING REPORT INFORMATION <br />SAMPLE CONDITION <br />SAMPLE TRANSPORTATION <br />SAMPLE INFORMATION <br />ANALYSES REQUESTED <br />REMARKS CUSTODY <br />Relinquished by:. <br /> <br /> <br />Relinquished by:. <br />Relinquished by:. <br />Date <br />Date. <br />.Time <br />Time <br />Sample <br />Number <br />Subject to Surcharge Field Sampler: <br />Time Milage: <br />Composite Sampler Setup: <br /> Time: <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQ VEST DOCUMENT <br />I <br />= <br />1 <br />I <br />I <br />i <br />I <br />I <br />If yes. To: State Client OtherAddress: t'A, <br />i <br />s <br />I s <br />I I <br />f <br />t J a'/,h <br />/ Celsus <br />() Leaking. () Broken. ( ) VOA Headspace <br />Custody Seal ( ) yes ( ) no <br />www[ <br />Time <br />Sample <br />V-) .po <br />I£ <br />I <br />& <br />£ <br />Date <br />Sample <br />8 z <br />§ <br />§ <br />3 o <br />6 <br />s <br />I <br />I <br />S <br />■I: <br />c <br />1 <br />8 <br />1 g <br />6 <br />6 <br />h H <br />11 <br />■C’ <br />ih <br />Hi <br />UHI <br />IH <br />Date JjM^ffmZ <br />Date Time. <br />Date Time. <br />Sampler (s): l\ <br />QA/QC report required: yes <br />Location Description <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (2091 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * <br />/ bVAnAv, <br />0 Received by: <br />Received by:. <br />Received by:.