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utlJON ui- LU-STODY REOF'1 <br /> i <br /> ' SAMPLER (signature) � i jt `` ;. `;� ,,,'• �� ' , i i . - i -� <br /> Phone: �' 6.,;.::•:3 : 5"3 ° , <br /> LABORATORY [r r SHIPPINl3 INFORMATION a c �5 i'`.}. i , <br /> r � ;.s'.'eC. ! Y'� { ,�'`'� �'`! y . 'ry L i'Y# � � .- -nx •`�'cr`i�5��}''},5}�f,�,- J q,, <br /> "rill. <br /> Ulll jRcSS .Shlpper ' <br /> as �� 1psKr` L '1�• 1 t� T t+ ..F'd/ •�)!{'x,' Addrlis <br /> r � �• � t�`h•< F lv+1� . � ...A\��110iJ \ i hYa I t �:1 *r e: .i.l l4rj �i+,l^/{L1r:-iS�_G �r� i.i•.i � r l a <br /> Date Shipped <br /> i.TURNAROUNR (TIME 1>=�wa1 i I {i✓ 9F� t r �: . <br /> Z CP ��EK"S Service Used <br /> Attention AICooler rbIIlNc. <br /> Phone Not$`L � a ' `` l h <br /> �f� 3 No YJ <br /> �.I rad • 5 1'_r •�O r� ��.1.s?y !�a ' , y` L I `J 4 •L <br /> P . - <br /> R ,11nquished by: ignatures) Re d b '(signs ss) _ Date _ Time <br /> � T ., � •;.I:: :.. ... i . ,.-. I .' IJ '�:. I tir:++�o fY,�'r.:" )I,}. , �+ ��, <br /> t r Received for laboratory by ' <br /> 5N'. .( I .. .. � �. :, _ I ! 1 .r.. v�t'�i , : :v� "R�.Y l;� ��" �! :(,• -4�1 �tl, I.._.. <br /> LABORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY CFESULTS <br /> Sample ,p Slta pab :r. x ,rAnalyses }r, 7 x Sample Condition <br /> No. I ldentilication 2 Sampled Rsquested f Upon Receipt <br /> I�AfJ �7 CAORA . HUpocR ��� fSOld O! OZO % J5-67y Ii <br /> IFt�1K2 �o ti 4-1 - 90/00 2I /5'67 d <br /> . 5�f-..� <br /> IN'-St; L/ - g'g Z / .: d <br /> �?( P�anccN uc n��s <br /> _- - <br />