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CHP 1N OF CUSTODY RE(-'ORD <br /> SAMPLER (signature): <br /> ,4,y�v/led GeoSystems <br /> Phone: C.1111s) 6s%- 1406 4325 fission Blvd. Suite B Fremont. CA 44539 1415)651-1%E <br /> LABORATORY: SHIPPING INFORMATION : <br /> ,�fl�;c� �r-enSys�c Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: - Service Used <br /> Attention: _��� , �-� �+ Airbill No. Cooler No, <br /> Phone No. <br /> Relinquished by: (signatures) Received by:(signature) Date Time <br /> 9!o0 4 <br /> Received for-laboratory <br /> LABORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sample Site Date Anaiyse Sample Condition <br /> No. Identif ication Sampled Requested Upon. Receipt <br /> 0 <br /> S-%S-134 B6Q�L \�-19-8b 63'Ex - Ex a.1� zcE <br /> S- 40-zK 864\- 4 \9-86 <br />