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California Water Labs, Inc. <br /> P.O. BOX 4249 _ <br /> 1430 CARPENTER LANE -SUITE G <br /> MODESTO,CA 95352 <br /> PHONE(209)527"4050 v V_' <br /> n <br /> CHAIN OF CUSTODY RECORD 4 <br /> PROJECT NAME: <br /> De G l cot ti 4 <br /> SAMPLERS (signature) Number �Qi v <br /> REMARKS <br /> of <br /> Station Con- <br /> NumberDate Time Y� Station Location tainers /� <br /> 6 Woo /\ AO P 3 FP — 6�-q U Z <br /> D 1S <br /> vo n <br /> J <br /> Rel ed by(s p tur 07 IU �() <br /> /I/Time Received by (signature): Relinquished by(slgnature): Date / Time Received by (signature): <br /> Compan or Ag cy: Company or Agency: Company or Agency: Company or Agency: <br /> Gv v- <br /> Rellnquishe� by(fiiKaturg): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency• f'( t Company or Agency: • . Company or Agency: Company or Agency: <br /> Relinquished by(signa ure): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> (signature) � Q <br /> Company or Agency:/q�- �, , IL <br /> S <br />