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MWOMMM0 <br /> : <br /> 'yr � ij _y �'U�'��2�ki � Y„i i,. «.�. + ,,Kn- '.v •n'� -.i• z,� •�ss <br /> CHAIN OF CUSTODY RECORD <br /> SAMPLER (signaturr`,): qpp/ied GenSysfemS <br /> cgi4 Power Inn Read,Saenntenta.CA 45825 (9161452-2901 <br /> Phone: �9a1 *Fremont aCoya Maa •5acrarnento� <br /> SHIPPING INFORMATION: <br /> LABORATORY: <br /> Shipper <br /> Address <br /> 1 [late Shipped �---- -- - <br /> TURNAACUNO TIME: !� Service Used ._ --�-- <br /> Attention: <br /> II Airbill No.. Caoler No. <br /> Phone No, J� <br /> Received.y '(sic atu as► (� Qat Time <br /> Rei' uiah d �1y: signmturesl �ceiv .1 � �,� pC }(to q �`� <br /> r <br /> Recaiyea 1nr laboratory by: <br /> LABCRATCRY SHCULO SIG,-1 UPON R C <br /> LABORATORY RETURN A <br /> RESULTS COPY OF THIS FORM WITH THE <br /> ra ie Condition <br /> Sample Site Date Analyses SaUnca Recviot <br /> No. identilication Sarnoied Re+auasted <br /> SuIf Aj!2-72L— r rDI R Pt1 /CEO <br /> A4 1?7CES <br /> -- <br /> r�H - s <br />