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CHAIN Coo CUSTODY RE000iD <br /> S91WP1��R "ture): <br /> C--.,C�1'�a <br /> 4191-E Power Inn 1)-.A <br /> S1tlwMS <br /> Phone. 9 �' L ?-9U/ ,Sacnmen[o.G1 9•", (716) 452-2901 <br /> • 'lemon[ •Cove Meed •S�aamamo <br /> LABORATORY:l $HIPPING INFORMA710N : <br /> /O�i e-in <br /> 3.3 <br /> Shipper <br /> Z '^``'x Address <br /> / Date Shipped <br /> TURNAROUNDTIME: Service Used <br /> Attention: JTlL� Alrbill No, <br /> Cooler No. <br /> Phone No. qp/ <br /> R iahe b : (sipnaturea) R vW :lalgpaturwl � Dac <br /> d Time <br /> 3':3n <br /> Recelved far laoorotory by: <br /> LABORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sample Site Date <br /> Anal aes <br /> Nom.. Identhtl`n Sampled Requested Sample Condition <br /> Upon Receipt <br /> I -TZ <br /> S • <br /> �- 17-75 <br /> I <br /> 1 <br />