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• CHN OF CUSTODY RECORD <br /> SAMPLER (signature)' App/led GeOSystems <br /> 6���) yJ�� _2y o 4.325 `licsion Blvd Suite 6 Fremont. L A 9453914151 fi51-19(1fi <br /> Phone: ' <br /> LABORATORY: SHIPPING INFORMATION : <br /> Shipper <br /> Address <br /> Date Shipped <br /> TURNAROUND TIME: Service Used <br /> Attention: �� T9c Airbiil No. Cooler No. <br /> Phone No. �yi� GS/-/rac. <br /> Relinquished by: (s' atures} Received :(signatures} Date Time <br /> Received laboratory y: <br /> 17/3 <br /> LABORATORY 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 Sampled Requested Upon Receipt <br /> 7 A?0/,9 C ,nom, E T H <br /> S-Rc�9�en z E'70 C-_ 2- <br /> .S' 7:,3 &I 9/Ii-,q 2`7 c.-z 7 leo/u 7 <br /> C <br /> .S-r2. 1 W2AC, 9 43 036—L 7 /jJ/"i 7 C <br /> S- r:2 _3f,, .T -G ,¢7o-3&--L 7 3o/b7 <br /> 3�) cl'� <br />