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CHAS14 OF CUSTODY RECURD <br /> S L5R (signature): <br /> i� ne•vR�' Ems' c H u JL,ws,�3 ._ Ag olied GeaSy'StC'ms <br /> _ 4191-E Power Inn Road,ACUrnento,CA 45816 (576)452-2401 <br /> Phone: 2C)o f — .Fremont •Costa Mesa •Sacramento <br /> LABORATOR SHIPPING iNFOR&4ATiON: <br /> G^5 �-�rtC��+t�`, xt Shipper <br /> Address <br /> I Data Shippad <br /> TURNAROUND TIME: IQ���-S Service Used <br /> r�1 Attention: •Znee–usAErbi[INo. CooierNo. �.�_ <br /> r <br /> PllOnef'a0. lQ►• <br /> 'ng est by:(signatures) 9tsceived by:(signatures) Data Time <br /> Lj <br /> Recaived r laborat razor//hV <br /> f4'---ABORAT0RY 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 Sarnoled Requested Upon Receiot <br /> 1 <br /> - <br /> s <br /> S-a A C� I 1 l 1 <br /> ? I � <br />