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& ¢ <br /> W <br /> 2 <br /> CHAIN OF CUSTOD ■ RECORD <br /> AM <br /> �MPLER (signature,: �`~�--- <br /> KCcn Taos <br /> W-Rl7/Afs <br /> 4191-E Power inn Road.Sacramento,CA 950116 (916)4,52-2901 <br /> Phone: z^ U oFremont •costa Mesa •Sacramento <br /> LABORATORY' SHIPPING INFORMATION: <br /> �/7i`t;J �ey��� t° s -- Shipper <br /> C-4 _ Address <br /> Date Shipped <br /> TURNAROUND TIME: 7 (t 1�� > Service Used <br /> Attention: (IL"P �r,'c ' Alrtsill No. Cooier No. . <br /> Phone No. 's�� 90 f <br /> Relinquished 4y: signap't#1 Received by:(signatures) Date Time <br /> IReceiv or iaborator/fir by: -72 <br /> *':N ORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sample Site Date Analyses Sample Condition <br /> Mo. Identification Sampled Requested Upop Receipt <br /> -42 S ? r M <br /> W -71 -Mtu` s o _Z :2�z z A-1R7 �- <br />