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MEN <br /> rm,�� <br /> ME <br /> - Y r. <br /> 1 <br /> CHAIN OF CUSTODY RECORD <br /> SAMPCERS:(S1gr..tu 1 <br /> -- —.�'%�f7 .�_�7'•r _ SHIPPING INFORMATION <br /> QIP TO: ' Shipper <br /> �j�} r�s l f; yer.r n� l"}G 4�n•}: - Address <br /> T S 4 - F_ SIS 03 Date Shipp3d <br /> _ TI 7 Shipment Ser,ice --- <br /> Airbill No. <br /> M ATTENTION: Cooler No. <br /> Phone No. Dale/Time <br /> Rel ouished by:{ 'gnaturle-)y�� Received by:15ignarural <br /> Date/Time <br /> Retinquish9 :(Signature; Received by:rS19narure) ` <br /> Date/Tim <br /> Received by:r5gnarurel e <br /> Relinquished by:fSlgnarure) <br /> Relinquished by.(Signature) Rer ive for labors ory hy':rSignarurel ITime <br /> �ate <br /> ) <br /> "Y s- <br /> 'Analysis laboratory should com?tete,"sample conditi n upon receipt',section below,siqn and return top copy to <br /> A P P L,INC. 4203 WEST•SWIFT. FRESNO, CALIFORNIA 93722 <br /> Sample Condition <br /> Sample Site Date Analysis Upon Receipt <br /> Number Identification /Sampled Requested - , <br /> i <br /> /' <br /> f �t3 If /r <br /> f <br /> Form A-352(Rev.7182) A P P L, INC Pink-Lab courtesy Copy <br /> Whsle-Sampler canary. <br />