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CHAIN OF CUSTODy <br /> RECORD <br /> DORD <br /> t <br /> A S '"R lgi nature►; <br /> Z-- <br /> Phone: if 1 11,G . M �'A.o/iet?' 61 D--o <br /> `a�'2 [^ 4141-E Power inn Road,Sacramento.Cr19S816 <br /> LASORATORY: •fr� e~mo� n, • 1916)452-.2901 <br /> Costa Mesa •5acramento "�—� <br /> Q,7►�`r �' SH'PPlNG INFORR+tATlON: <br /> Shipper <br /> Address <br /> TURNAROUND TIME: Date Shipped <br /> -� <br /> 0 Attention: " Service Used <br /> Phone No, i Airbill No. <br /> _.2�. 290/ Cooler No, -------- � <br /> R fished (signatures) ~ <br /> R ived, y:(signatures) pate <br /> Time <br /> 04 lql <br /> ------------ <br /> heceived <br /> _ for laboratory by: _ <br /> �- .� RATORy SH ilial? SIGN UPON RECE3PT l�- ! �� <br /> � L� 918 ; <br /> AHC A COPY OF THIS FOFim WITH THE <br /> z LABORATORY RESRETURN <br /> ULTS <br /> Sample <br /> Site <br /> Nom• ldentiflcation tats Analyses <br /> I Sampled Requested Sample Condition <br /> "_. W• !'" � ? Tvae �i?! Upon Receipt <br /> L' �3 az 7P <br /> ---------------------- <br /> m""" —-- <br />