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CHPaN OF CUSTODY RECORD <br /> SAMPLER (signature): An&�� <br /> .11 Q::,� Applied Geosystems <br /> Phone: q/G� Q T Z_ ^' �q`p 4325ti Nlistiu,n Blvd Suite B Frem,mt. Cry 94539 (415)651-1906 <br /> LABORATORY: SHIPPING INFORMATION <br /> �. I - ,Q /S TE)_l Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: 44 11 V Service Used <br /> Attention: NbL7 L S4-I Airbill No. Cooler No. <br /> Phone No. �nr r' L� ty =9 () (.,_._ <br /> Relinquished by: (signatures) Received by:(signatures) Date Time <br /> 1 '. 25,3 Pa., <br /> Received forlaboratory 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 Sampled Requested Upon Receipt <br />