Laserfiche WebLink
CHQ y OF CUSTODY REC;�D <br /> �-' � Y•YrnTver'!�F�' - <br /> SAMPLER (signature): <br /> ,.,4ioie7//sd ' Bo sl�/r�►.t <br /> 4191-E Power inn Road.Smaento,CA 2%X (916)452-2901 <br /> Phone: m <br /> •Fremont •Costa Mesa . •Sacran+enee <br /> LABORATORY: SHIPPING INFORMATION: <br /> Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: Service Used <br /> Attention: Airbill No. Cooler No. <br /> Phone No. <br /> Relinquished by:(signatures) Received by:(signatures) Date Time <br /> Received for laboratory by: <br /> LABORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> W LABORATORY RESULTS <br /> Sample Site Date Analyses Sample Condition <br /> No. Identification Sampled Requested Upon Receipt <br /> W <br /> W <br /> W <br /> EXAMPLE OF <br /> CHAIN OF CUSTODY <br /> PLATE P- <br />