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CHAIN OF CUSTODY RECORD <br /> SAMPLER ( re?: <br /> e QidP/ied GeoSysd�m� <br /> Phone: �9/zl� Q�2—?9d/ <br /> 4191-E Power Inn Road,Sacramento,CA 95826 (916)452.2901 <br /> 1 <br /> •Fremonr •Costa Mesa •Sacramento <br /> LABORAT�RY: SHIPPING INFORMATION: <br /> 49 Shipper „ <br /> Address <br /> Date Shipped <br /> TURNAROUND TAME.' �4== `��:t2 Service Used <br /> Attention: /T=`i ��rrra� M AirbillNo._ Cooler Nn. <br /> Phone No. <br /> Aalinqui by: ig ores) Rece' ed y:(Signatu es) f Date Time <br /> Received-torlaboratory 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 />