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M. - a <br /> e <br /> ffiM i " om' <br /> x <br /> o <br /> _� <br /> fix.. <br /> CHAIN OF CUSTODY RECORu <br /> SAM Pt.EFS':(Stgnsture) � J <br /> SHIPPING Ii:FflRMAT10N <br /> one: ! ( <_4� � -z9Z- 73-t/• <br /> _HIP TO: Shipper <br /> Address <br /> F ri� S !! Date Shipped <br /> yj�� 54�,� I�` C 4-�I�� Shipment Service <br /> - Cir}' <br /> �,r`� r •5 7 Airbill No. <br /> ATTi=NTION:_ Cooler No. <br /> Phone No.. �.�of 1 ?i - - - Zq- - `37341 <br /> Relin ished by: fSiq pure) Received by: fsrgnarurel DatelTime <br /> Date/Time <br /> Relinqul hed by:fSignerure) <br /> gprejup <br /> Relinquished by: (Signature) Received by: is+gnarure) DatelTime <br /> Relinquished by:(s;gnatu,e) Fce e for laboratory by':rs+gnarurer _ ate/Time <br /> 'Analysis laboratory should complete. "sample condition upon receipt", section below, sign and return top copy to <br /> A P P L,INC. 4203 WEST SWIFT, FRESNO, CALIFORMA 93722 <br /> Sample Site Date Analysis Sample Condition <br /> Number Identification Sampled Requested Upon ec$ipt <br /> �! -052 z� ,or +� �� PScZ %. ;'Z7c ��.��(� (dC�( �r,lL L7' <br /> �Z <br /> �z-lD�-Szr� <br /> 5-35 Q <br /> 5--yob-13 z <br /> 5�7 � g�Y�-QZ7o <br /> S-SS—QZ �+CIr <br /> For mA-392(Rev.7)92) A P P Lr INC Pink-LabCaurlasy Copy <br /> White-Semptar Canary- <br />