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CH, ,IN OF CUSTODY REL-ORD <br /> ray SAMPLE signature): <br /> �.- � App/ie4 GeoSystsins <br /> 4191-E Power Inn Road,Sacramento,CA 95826 (916)452-2901 <br /> Phone: r Z • Fremont •Costa Mesa •Sacramento <br /> LABORATORY: SHIPPING INFORMATION= <br /> G S Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: Servme Used <br /> Attention: Q-5k Alrbill No. Cooler No. <br /> Phone Nrf:, TtG-�:�j 1; 2- Z 112 <br /> RelingO' hod by: (si s�tur Ric ved by:(signal es) Date Time <br /> la <br /> Received rbo story by�� !G <br /> ABORATORY-9, fULIJ SIGN UPON RECEIPT AND 'RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sample Site Date Analyses Sample Condition <br /> No. Identification Sampled Requested Upon Receipt <br /> 75GOg I G 70,j 3 a <br /> o �, <br />