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i <br /> 1 <br /> CHAIN OF CUSTODY RECORD <br /> OR <br /> t~E-R, <br /> ( irel: APP/ie'd G�asySf�e9rs <br /> : �`s �4S I 41:x' xlhcutvn 51M 5utie B rmmnni.CA 1141,111 :41 SlhiI IVKIi <br /> Phone <br /> LABORATORY: SHIPPING INFORMATION: <br /> (, S Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: � V � --- Service Used <br /> Attentian: e-Z O,L, A d Airbili No. Cooler Me... ..--�-- <br /> Phone No. r - 6 1 — 1 O G <br /> Relinquished by:( 'gnatur ) Recoived by:(signatures) Data Time <br /> (y-17- 7 g <br /> Received-lata Iaborato�Y: <br /> LABORATORY SHOULD SIGN UPON RECEIPT ANDRETURN RETURN A COPY OF THIS FORK! WITH THE . <br /> LABORATORY RESULTS <br /> Date Analyses Sample Condition <br /> Sample Site <br /> No. Identification Sampled Requested Upon Receipt <br /> t To-d4- <br /> �- 7a - ddWI <br /> r <br />