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fc. F <br /> CHAIN OF CUSTODY RECORD <br /> SAMPLER (sign tura►: <br /> I}�r, <br /> 4A011 Ger�Sys�'�ms <br /> 4191-E Power Inn Road,Sacramento.CA 95826 1916)452-2901 <br /> E <br /> Phone: •Fremont •CUM Mesa •Sacramento <br /> LA®ORATOFI ..- SKIPPING INFORMATION: <br /> I)nnh 0-i �,e.� �`/5 t?rV1 i Shipper <br /> Address <br /> f'f e/t'1or± Cate Shipped <br /> TURNAROUND TIME: 2-„Vtf— Service Used <br /> ' Attention: ler"r., /Vf'[C-yS-- Airbili No. Cooler No. <br /> a Phone No. .. <br /> IRelinquished y:(signatures) Received by:(signaturesi Date Time <br /> Received-for)laboratory Y. <br /> 1LABORATORY SHOULD SIGN UPON RECEIPT AND RETURN .A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> SantPle SRO lata Analyses Sample Condition <br /> . No. Identification Sampled Requested Upon Receipt <br /> S—+S -i s- f -6� �37US z51B 7�c iCe�c�. <br /> T }i <br /> t <br /> i <br />