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Cr iAIN CF CU%S i t, C'! R=;�^ C <br /> SAMPLER ignature)' <br /> P,�" 4 Ago/led GeoS ;s ems <br /> Phone: <br /> 4'191-E Power Inn Roaa.Sacramento, CA 95826 (916) 452-2901 <br /> �9/�) 4s�- �y�/ <br /> • Fremont •Costa ,'Mesa •Sacramento <br /> LABORATORY: / SHIPPING INFORMATICN : <br /> 56,/ 6'ie" Z �r Shipper <br /> 733 fi<r4o gy14 4l eiiuc Address <br /> J"- 6"/,-r C4 Date Shipped <br /> TURNAROUND TIME: Service Used <br /> Attention: 4,0a y Airbill No. Cooler No. <br /> Phone No. ���� Ursa-iso/ <br /> Relinq ed by: (s at Re iv by:(signature tDate Time <br /> CIS <br /> I <br /> I I <br /> I Remvea-f arjaooratory 5y. I `' <br /> LABCRATCRY SHOULD SIGN UPON RECEIPT AND REi URN A COPY OF THIS FORM `NI T H THE <br /> LASCRATCRY RESULTS <br /> Sample Site Date Analyses Samoie Condition <br /> No. Identification Sampled Reauested Uoon Recaiot <br /> CFO <br />