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tx <br /> ' <br /> CHAD- I N OF CUSTODY R EC! ORD <br /> SA PLER (signature): <br /> 4=0- <br /> Inn Road,Sacramento, <br /> Phone: �Qi's� �S2 ' 2- 9O 4191-E Power I <br /> / 95826 (916)452-1901 <br /> r`� •Fremont •Costa Mesa •5acramenio <br /> LA80RA7DAY: SHIPPING INFORMATION:16 <br /> Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: _ L.t Ssrvice Used <br /> Attention: /ALLY Z-V-rH Airbiii No. <br /> ...L g'�� g-s�—�9A Cooler No, <br /> Phone No. , <br /> Relin ished bY:(signatures) Received by:(signatures) rata Tirlie <br /> Receive or laboratory by: <br /> _ 1-1 H? S:o o <br /> ,,,,.-ABORATORY SI:OULD SIGN UPON RECEIPT. AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sample Site Date Analyses Sample Condition <br /> No. <br /> Identification Sampled�•�_ � � P Requested Upon Receipt <br /> „ <br />