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�- CWAIN OF CUSTODY RE'-CORD <br /> SAMPLER—Wgnature}: ` <br /> Applied GeoSystems <br /> 4191-E Power Inn Road,5acramento,CA 95826 {916}452_2901 <br /> Phone.' _...���' '_ / <br /> • Fremont •Costa Mesa •Sacramento <br /> LABORATORY: SHIPPING INFORMATION: <br /> Shipper <br /> Address <br /> &01 t%C Date Shipped <br /> TURNAROUND TIME: Gj Service Used <br /> ,•, Attention: Airbill No. Cooler No. <br /> Phone No. <br /> Relinquis by: ignaturesj Received by:Isi natured) Date Time <br /> Receive !:r�1,aboratory by: <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 />