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CHAIN OF CUSTODY RECOPD <br /> .. ✓ � r <br /> '�_— " <br /> SAMPL R (signature): <br /> -I A,�p/led GeaSystems <br /> 4191-E Power Inn Road,Sacramento.CA 9SB26 (916}452-2901 <br /> Phone: 5� • Fremant •Casta Mesa •SaRarttent0 <br /> LABORATORY: SHIPPING INFORMATION : <br /> Amis'P d 6-P n tf(- f Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUNO TIME: Service Used <br /> Attention: GAr Alrbill No. Cooler No. <br /> Phone No. 6 4z `Z U <br /> Relinqui ed by: (so s res> Received by:(signatures! Date, Time <br /> V <br /> I <br /> Receiv or laboratory b j I JIT6- <br /> LA80RATORY <br /> 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 /> 3��#4/-/ C /Ce,(J" /,op_ C�_ <br /> IA)-/1 3 TP_ I� CL <br /> V <br />