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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Client: O',Ian anf� 'm��ph�► 7Spler(s):\ gooll"V HtinP(( Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: <br /> Time: QA/QC report required: yes no <br /> Address: P.0• �ox 2ljSQ Subject to Surcharge Field Sampler: If yes,To: State / Client/ Other <br /> L o 9; cc, Q 5 Z-1 I Time Milage: Lab number: 3 4 L iq C u C <br /> Phone: (tou) 33 1 w N DKOL630191 N N 1• <br /> _ x <br /> a Sample Temperature: Celsus <br /> FAX: °°=a a <br /> i1 s Cp p z <br /> Leaking. O Broken. ( )VOA Headspace <br /> Project name: 2 3 q d ai lly Rd m11n0r �Q 6 s F A N Custody Seal( )yes o <br /> ° u Z <br /> SAMPLE <br /> Contact person: 8dley �lcn"Xle �' S TRANSPORTATION <br /> �a <br /> m o <br /> c )Ice Chest ( )UPS ()Fed Ex rop off ( )Other <br /> • <br /> o .g� o <br /> Sample Date Time g g a e z <br /> 7(,z <br /> ation Description 0 3 3 a ZE <br /> A <br /> Number Sample Sample z> <br /> —C I �w-�� r� � �!/3 ►3 : �o P 1firC\kt's <br /> D�;Cp <br /> Relinquished by: 13fGd1tV 011461 Date ir3 Time 13 , 3Z- Received Date 431,14 Time <br /> Relinquished by:_ Date -Time.--Received by: Date Time <br /> Relinquished by: Date __Time_ Received by: Date_ Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle®petallab.com * WW4 Page 6 of 6 <br />