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In"W'S'.1 NINE, ,}.tet �` _ rm'mc�'k- a - - , <br /> CHAIN OF CUSTODY RECORD <br /> SAM P ER <br /> _,_�ltAr �II1P/) 9 frrrr �r7.1Pr^ _._ �Q�/led Geo�Sysf�ms <br /> Phone ����� �S2 — z�d/ 1191-E{'ower Inn Road,Savamenlo,CA 95826 1916)452-2901 <br /> •Fremont •Costa Mesa •5acramento <br /> LA80RATORY: SHIPPING INFORMATION: <br /> /�P�IED �}�af7�i1JS Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: Service Used <br /> Attentfan; Gv Alrbill No. Cooler No, <br /> Phone No. (9l6, 3"Z-290/ <br /> Rely in uishe tui: Ignatures) <br /> f Received by:(signatures) Date Time.�i; <br /> Received labarat^ory/ <br /> QB�OnATOV SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> k LABORATORY RESULTS <br /> Sample Site. Date Analyses Sample Condition <br /> No. Identification Sampled� Requested Upon Receipt <br /> 70SLV-3 -LIP- <br /> 7,-fe- <br /> P7CSp-3 <br /> r <br />