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MEW <br /> CHAIN OF CUSTODY RECORD <br /> r1 <br /> "A�.•1TrY7 NF�r <br /> M <br /> � � d. <br /> 'VIPLER (signature): <br /> 41814 Power inn Road,SaeraneMM,CA j= MQ 452-2901 <br /> Phon®: s Fremont •Casts Rom •snmoarnel <br /> LACORATORY: SHIPPING INFORMATION: <br /> Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: Servics Used <br /> Attention: A1rbill No. uoaler No, <br /> Phone No. <br /> Relinquished by:(slgnaturos) Received by:isignaturas) pato Tlrne <br /> Q'7 <br /> Received for laboratory by: <br /> r-^BORATORY 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. identliication Sampled Requested Upon Receipt <br /> to <br /> EXAMPLE OF �.. <br /> .r_.._ <br /> CHAIN OF CUSTODY <br /> PLATE P• -- <br />