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CHAIN. OF CUSTODY RECORD <br /> r <br /> SAMPLE, ign�,Wr <br /> A,op/ied GeaSyste�ns <br /> / <br /> 4191-E Power inn Road,Sacramento,CA 9SB26 (916)452-2901 <br /> 9�z -z 90/ <br /> phone: • Fremont •Costa Mesa •Sacramento <br /> LABORATORY: SHIPPING INFORMATION : <br /> Shipper <br /> .r <br /> Address <br /> �cfioNT If _ Date Shipped <br /> TURNAROUND TIME: � wC��- Service Used <br /> Attention: %A2% ,cT� � Alrbill No. Cooler No, <br /> Phone No. 19/'6 ) <br /> Relinquished by. (signatures) Received by:(signaturesl Date Time <br /> Received boratory by:' <br /> IT 3-0 <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 /> " 757-io-mac// :?9j.5z$e <br />