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` CxA,s4 OF CUSTODY RECUAD <br /> l `r <br /> SAMPLSR (signature): f A'Op/iso' Geosystems <br /> 4191-E Power Inn Road,Sacramento.CA 95826 (916)4S2 <br /> U"4` r •Fremont •Costa Mesa •Sacramento <br /> Phone: — <br /> SHIPPING INFORMATION. <br /> LABORATORY: <br /> r'i' .rF` s oSr� u t Shipper <br /> Address — -- <br /> Date Shipped <br /> TURNAROUND TIME: Service Used <br /> Airbill No. Cooler No, - <br /> Phone No. /! <br /> Dste Tirrte <br /> Relinquished by:(signatures( R a! Isignattuesy 8 140 <br /> ,r J <br /> r Lk <br /> Rocaive far laboratory b : db -awl <br /> _ :ASORATORY SHOULD SIGN UPON RECSIPT <br /> SORPeT AND <br /> RETURN RESULTS COPY OF THIS FORM WITH '?HE <br /> Date Analyses Sample Condition <br /> Sample Site Requested Upon Receipt <br /> No. Identification Sampled_ -- — r <br /> ....... .. I cr y +IOU (14 <br /> VL' ) <br /> �So <br /> ------------ <br />