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"�' �— � � � "^ �w gid' "" "�'�s_ ��. � -y. � •x `"� �,.vy _! n:�i:f .i �rv��' pia. <br /> 4 <br /> CHAIN OF CUSTODY RECORQ <br /> SAMPLER (signature}l� <br /> �r :lr �� A,vp/ied GenSWems <br /> Qui, . [^r�,�ry' 4191-E Power Inn Road,Sacramento,CA 95826 {916)452-2901 <br /> Phone: •Fremont +Costa Mesa Sacramento <br /> LABORATORY: _ SHIPPING INFORMATION: <br /> Shipper <br /> Address <br /> pate Shipped <br /> TURNAROUND TIME: �•Ai , �.}D P-c Service Used <br /> Attention: r'��� tr Alrbitl No. Cooler No. <br /> Phone No. <br /> i <br /> Relingpished by:(signatures) Received by:(signatures) D to T]me <br /> 3, Recalved laboratory by' <br /> a �ABORATORY 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 Samplad Requested Upon Receipt <br /> 4-`2 137 r <br /> L <br /> i <br /> t { <br />