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CAIN OF CUSTODY REfORD <br />S LEA (signature): <br />Phone: <br />A,00/ied GeoSrstems <br />4191-E Power Inn Road, Sacramento, CA 95826 (916) 452-2901 <br />• Fremont • Costa Mesa • Sacramento <br />LABORATORY: SHIPPING INFORMATION: <br />/103/GG GHG�! LfJ/�C' Shipper <br />Address <br />Date Shipped <br />TURNAROUND TIME: Service Used <br />Attention: 4LX Airbill No. Cooler No. <br />Phone No. jib-) ¢-f 2 '29o/ <br />Rel}'quished by: (signatures) Recai by: signature 1 JD/ateTimr <br />a� �(1 �$�� 9-- RSI /3 , <br />Recce tcrlaboratory 5y: <br />I �-, ; 1 > _ , Y, ,4,,I _ P � _ I 1-1-XR1 4 ; <br />LABORATORY SHOULD SIGN UPON RECEIPT AND_;(ETURN A COPY OF THIS FORM WITH THE <br />LABORATORY RESULTS <br />Sample <br />No. <br />S- 9— �✓oT <br />7 <br />Site <br />Identification <br />38ds/-/ <br />Date <br />Sampled <br />9- / - 68 <br />Analyses <br />Requested <br />TSH � AyT'i1GE' 6 Ssv <br />Or 3SYD prtp�'3 M4 <br />80/0 <br />G�ro„ui.. 2Z,,d <br />Sample Condition <br />Upon Receipt <br />