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CHi-%jN 4R CUSTODY RECURD <br /> SAMPLER (signature): <br /> p�%�� GeoSysfa�ms <br /> Phone 4191-E Power Inn Road,Sacraments.CA 95826 (916)452-2901 <br /> •Fremont •Costa Mesa •52cramento <br /> LABORATORY: SHIPPING INFORMATION: <br /> Shipper <br /> Address <br /> Date Shipped _ <br /> TURNAROUND TIME: � Service Used <br /> Attention: A'�!�Y ��f H .. Airbill No. Cooler No. <br /> Phone No. �f6) f S2-X90 <br /> Resin 'shod by: (signatures) Received by:(signatures) Date Time <br /> Receive or laboratory by: , <br /> i LF <br /> ABORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sampie Site Date Analyses Sample Condition <br /> No. identification Sampled RegLested Upon Receipt' <br /> Lx <br /> K/—S/• tit w L r �� �... f`iS 9 8 <br />