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CHAIN OF CUSTODY RECORD <br /> SA !. R i ature} <br /> G490- ems <br /> 4191-E Power inn Road Sacramento, CA 95826 (916) 452-2901 <br /> Phone g i�, S - o ! <br /> Fremont Costa Mesa Sacramento <br /> LAB RATORY �'�T�O6i1e �"'� �`6 SHIPPING INFORMATION <br /> 'S�r'i Aper <br /> Address <br /> � a <br /> Date Stripped <br /> TURNAROUND TIME Service Used <br /> F Attention —kr PaVfj57V:Z::>_ R_ Airbill No. Cosier No <br /> Phone No 4'sr2 2 40, <br /> R Is y (signatures) Recai by (signet res) Date Time <br /> Regyv for laooratory by > <br /> LABORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sampie Site Date Analyses Sample Condition <br /> No Identification Sampled Requested Upon Receipt <br /> S�zz - 67 <br /> s-a z /-/ <br /> 5- 22 - Z <br /> s• za �' �, <br /> S• iP P ` <br />