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»� �'T's+.ws ���. t :,. r.. s - k . „-fir _ a` ' v.. •� 1-6 !L, - r'� <br /> CHAIN OF CUSTODY RECORD <br /> SAMPt-ER (signature): <br /> 191940 stB/nS - <br /> "+! 4191•E Power lnn Road,Sacramento,CA 95026 (916)452-2901 <br /> Phone: - <br /> •Fremont +Costa Mesa +Sacramento <br /> LABORATORY; SHIPPING INFORMATION; <br /> Shipper <br /> Address <br /> Dale Shipped <br /> TURNAROUND TIME: _ ►vc� Service Used <br /> Attention: � 1�,•urc.` AlrbillNo. Cooler No. .� <br /> ' Phone No. � •.., -_ <br /> j <br /> Relinquished by:(signatures) Received by:(signatures) Date Time <br /> , <br /> ha /Va <br /> r <br /> F Receive r laboratory b <br /> `C-,� BORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sample Site Date Analyses Sample Condition <br /> IdentificationSam led <br /> P Requested Upon Receipt <br /> copy <br /> � _ E _ <br /> IVV <br />