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CH. l OF CUSTODY RE(ARD <br /> SAMPL (signatur Applied GeoSyste/ns <br /> e 4191-E Power inn Road,Sacramento,CA 95826 (916)452-2901 <br /> Phone: rfj4.) ��-��� ( • Fremont •Costa Mesa •Sacramento <br /> SHIPPING INFORMATION : <br /> LABORATORY: <br /> /I Car tet? �rtt3n [Alt! Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: Z� l� Service Used - <br /> Attention: eft _ Airbill No. Cooler No. <br /> Phone N4 <br /> q had by: (sigpat R i by:lsi n lure ) Date Time <br /> Relin <br /> ,(G (Scs) & ,b <br /> Rece',red-tor--laboratory-by: <br /> LABORATORY SHOULD SIGN UPON RECEIPT AND—RETIU" 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 /> iS-S- Wo, 03$D�tg-t -T-6 4 r3so n3�Ko, teEU <br /> wr o) <br /> �Lk(i ` K010 o,,STLW) <br /> NC-T"S IC AfsS1 <br /> l r n1 <br /> �UU <br />