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PRECISION EN-VIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST D0C1'A1E_-\'"1 <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Rush Analysis: 5 Days^2 Days_24hrs_ <br /> Client: Sampler (s <br /> Composite Sampler Se p: Subject to surcharge <br /> Customer Number: <br /> ((��,, Date: Time: QA/QC report required: yes no <br /> Address: e.19� � Subject to Surcharge Field Sampler: If yes,To: State Client Other <br /> �u 9 LOGIC. Cam• '99 0/ Time _ e:Mila <br /> g Lab number: � (�� -`-' <br /> Phone: t� '-�T P 2- �` SQL _ <br /> SAMPLE CONDITION <br /> w U <br /> a Sample Temperature: �, Celsus <br /> FAX: 3 <br /> n a o; s z m ( ) Leaking. ( ) Broken. ( ) VOA Headspace <br /> Project name (.'4 5 a a Custody Seal ( ) yes ( ) no <br /> G a Q N Z SAMPLE TRANSPORTATION <br /> Contact person: C $ x <br /> 3 b ( )Ice Chest ( )UPS ( )Fed Ex ( )Drop off <br /> • ' ;E a q a )Other <br /> gv3 _ o <br /> Sample Date Time �c a 3 �R z <br /> ANALYSES ItEQUE'STEI) <br /> Number Location Description Sample Sample P Z° E � g <br /> I0.3 30 47 ,3 KP w 37 <br /> G <br /> �� A <br /> — -- Relinquished by: Date ime Received by: JV� Date ( 2 ime 1 L v T <br /> Relinquished by: _ Date —Time Received by: Date Time <br /> Relinquished by: Date mime Received by: Date ►ime <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.com <br />