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n a a —�� --: 4 - <br /> OF CUSTODY REC,JRp <br /> ~y/ SAMPLER (signature): <br /> A,oTda,� <br /> o�lieos�sre <br /> Phone: 4191•E Power Inn Road,Sacramento,CA 94826 <br /> •Fremont . 19151 442-2901 <br /> LABORATORY: Costa JNesa • crcr4mento <br /> SHIPPiN INFORRAATION: <br /> Shipper <br /> -- Address <br /> �"—`—�~-- <br /> Data Shipped <br /> TURNAROUNrJ TIME; <br /> Service Used <br /> Attention: <br /> Alrbill No. <br /> Phone Nc;. Cooler No. <br /> . <br /> Relinquished by:(signatures) <br /> Received by:(signatures)- <br /> !}ate Time <br /> Received for laboratory by.- <br /> LABORATORY S1i0ULf) SIGN UPON RECEIPT ANQ RETURN A COPY OF TWlS FORM WITHTWE <br /> ' <br /> LABORATORY RESULTS <br /> Sample :lte Date <br /> WenNo. Sampled Analyses Sample Condition <br /> Requestt=.d Upon Receipt <br /> ------------- <br /> ------------- <br /> ------------- <br /> -------------- <br /> PLATE <br /> �--_ P_5 <br /> EXAMPLE OF <br /> CHAIN OF CUSTODY RECORD <br />