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CHAIN OF CUSTODY RECORD <br /> SAMPLER (signature): / <br /> �' �� u.�clr�r' Apo/led GeoSystsms <br /> Phone: Z` ' <br /> 4191-E Power Inn Road,Sacramento,CA 951126 (916)452-2901 <br /> 5� <br /> • Fremont •Costa Mesa •Sacramento <br /> LABORATORY: SHIPPING -INFORMATION : <br /> Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: G Service Used <br /> Attention: -)u /-n e Airbill No. Cooler No. <br /> Phone No. <br /> Relinquished by: .signayur ) Received by:(signatures) Date Time <br /> Recely or laborator by: <br /> LABORATORY SHOULD 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 Samoled Requested Upon Receiot <br /> TA=X <br /> t - <br /> 42 -1G)3 2- , r., , ,, <br />