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CHAIN OR CUSTODY RECORD <br /> SAMPLERS:(Slgneturr C --�. S—HIPPING INFORMATION <br /> Phone: �q .Z�o l Locations-4�o�ti <br /> SHIP TO: _ <br /> Shipper <br /> Address 1 0-7 <br /> Date Shipped <br /> Shipment Service <br /> ATTENTION: <br /> Airbill No. <br /> Phone N <br /> R <br /> Cooler No, <br /> re) ed by:(Signature) <br /> DateIrme <br /> Relinquished by: (Signature) f <br /> Rec ived by:(S ature) DaterTime <br /> Relinquished by: (Signature) <br /> Received by.(Signature) Rate/Time <br /> 3eltnquished by:{Signature) Received for laboratory by:(Slgnarure) Datefrime <br /> Analysis laboratory should complete "sample cond. upon receipt" section below,sign and return copy to Shipper <br /> Sample No. Of Site Date <br /> Slumber Cant, identification Analysis Sample Cond. <br /> r! Requested Upon Receipt` <br /> tetks: <br /> S0 39Vd 01N3WCdDVS NVZVdA ZZZZV99916 6Z:5T 866T/L0/T0 <br />