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CHA.W4 OF CUSTODY RECD ,D <br /> OLT sL a �- L JMr <br /> UCc+J U�I <br /> AMPLER (signature): <br /> k ' CQ ,�� A,oA�ied Gea� srsrs'rs <br /> C�/6 l 5 ` z 9� 4191-E Power fnn Road.Sacramento.CA 95&26 19161452-2901 <br /> Phone. ro . Fremont •Costa Mesa •Sacramento <br /> LABORATORY: SHIPPING INFORMATION: <br /> MQLL Shipper <br /> ---�-_ Address <br /> Date Shipped <br /> TURNAROUND TIME: ����,�, _ Service Used <br /> Attention: 0J--- 1Airbill Nc ,, Cooler No. �.. <br /> Phone No. <br /> Relinquish by. (signature) Fete ed by:(s' 3�tureai 0 ate Time <br /> . vY2 ;-�f✓r��� 1 ,� v, sr�gQ� <br /> Fjeteiveo tar i rwatory <br /> ASORATORY SHOULD SiGN UPON RECEIPT 'ANO RETQWRN';A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Samole Site Hate Analyses Satnaie Condition <br /> No. identification Samoted Reauasted Upon Recetot <br /> _✓-;Y•/YlJ_s �� �/,; fey _Igaa <br /> -- <br />