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Client <br /> California SAMPLE CHAIN OF CUSTODY RECORD Address 95323 <br /> \ Water Labs (please print) Phone No. 8?(1-3/7�22 <br /> Proj. Mgr./Contact KQl/ Gc�Pldow <br /> P.O. Box 4249 Ship samples to: Pink-Field Copy <br /> Modesto, CA 95352 1430 Carpenter Lane White and Yellow-To Laboratory with Samples <br /> (209)527-0050 Modesto, CA 95351 Record of/ Yellow- Return to Client <br /> PROJECTISITE NAME: ANALYSIS REQUESTED <br /> 11,29 N llt'/le'v ST <br /> PROJECTICONTRACTIPO NO.: <br /> V <br /> AMPLER: ' c / / REMARKS/SPECIAL INSTRUCTIONS <br /> LAB USE ONLY /SAM LE n Cu�J a m NUMBER <br /> 1' <br /> LAB I.D. I.D. DATE TIME O ¢ COON-TAINERS `\ \ <br /> U c7 <br /> << P xI 1 <br /> AUU <br /> EN pERMIT/SERVICES <br /> LI ISHE�iBY SIG DAT /TIME RECEIVED BY SIGN DATE/TIME RECEIVED FO LABORATORY <br /> 71- BY(SIGNI: DATERIM <br /> RECEIVED: <br /> POLD AND INTACT OTHER PRESERVATIVE OYES ONO <br /> OOTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA: ❑FED X ❑UPS ❑OTHER: SHIPPING ORDER NO.: X024-Hr 02-Day lam"'-Day [110-Day <br />