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CVIN OF CUSTODY FJF_. ORD <br /> SAM I_ER (signature <br /> 4polie& Geosystems <br /> 7r d �/' - SSte^ �`.ti1R11 in 31vti � 11 1,V <br /> Phone: Stine 3 � Irr•ml�,,,. ,i a„) ;S"i'; <br /> Will <br /> LABORATORY: SHIPPING INFORMATION : <br /> Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: J- V11 Service Used <br /> Attention: Airbill No. Cooler No. <br /> Phone No. : Lc- <br /> Relinquished <br /> c- <br /> Reli- nquished 13 signatur ) Received by: [signatures) Date Time <br /> 7L <br /> Received for Tabor tory 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 /> �s o - lar 7 O - 7-V 1-1 E TX <br /> S - (00 - <br /> -15- <br /> 00 -- <br /> S - So - ,~3 <br /> ,S - �3o <br /> S - ha - , <br /> H <br />