iiKfiSA^

DOPING .corsrrROL%FORiyi^

^. j^T^iJ^fri-.;^^.--^-:']-. « ■. -

■ Fe d e ratip n.";^".p jsci pime'^^^

^Notification tie c'ohtrdie el accuse de'receptioh/NdtJticatiqn^

ifV

■ Vousatesc6hvoque(eliu'rircontr6le'aritidopageyY6[j^re

fNomet signature du1]elegu&Federal/.Name^end^gnatiir£p{fe^erBl.De1egate:^

M^decini

^Realisation du.controie /Test completion ^^^^'^^^p^i;^

.Date du prelevement/SampIng date ; ,

Echairtiltons A et B / Samples A and B '';'
CoQc rlacoffletcontainerln'/hotile Code ..

BUR995474

I

s-.O ;--. -■--(.-'-■^Sa-;!;

'■rSiJEchantilion d' urine insiiftisant/ Insiifficient urine samptelJSlsJifeif^^

-.--;.L--?»ig!lQg5

■.'?^

■'^OND "'':"'" '■'■'"""" '^T'''^- ' ■^,X?:ComnienUire5Suh

MedicamBtits declares avoir ele pris recemment/ Drugs declared to have ;-
,.&BeriVei:entl¥Used:"' ''■<'■'. •'■':■" ^: '''-.' ■■' ;"._.■,; ;.,-'".^

:Cohfinnation/Coai°ng:^^^y-^ T^rT^-t'^^Vi^gS^ M^-^^^^^^^^^^i^^g^

,3*^5^

Signature du Delegu^ Federal
SignBture of Federal Delegate

Z'^"

Will)

USADA 0228

ainpliii* Arttiiii au Lsbonniiire Nstionsl de Dapistage du dopage - 143. avenue lli>ger-SBiBngra - SZ290 Ch&tanar-M ■!>!»> ~ TiL:D1 46 GO 28 69