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Gwent — <br /> California SAMPLE CHAIN OF CUSTODY R R Address q��`�' oDts <br /> Water Labs (please print) CESConNoNo.-52z s� 933s, <br /> I / 0 0 5 2 NOV 1 4 1989 Mgotact <br /> I <br /> P.O. Box 4249 Ship samples to: Pink-Field Copy <br /> 209) 527-0050952 1430 Carpenter <br /> ter Lane Record /of ENVIRONMENTAL I IEALT�hite and Yellow-To Laboratory with Samples <br /> ( PERMIT/SERV �E3 ellow-Return to Client <br /> PROJECTISITE NAME: ANALYSIS REQUESTED <br /> D7 S, �t�FGtPit/r�9 5•T <br /> PROJECTICONTRACTIPO NO.: <br /> NA SAM L REMARKSISPECIAL INSTRUCTIONS <br /> LAB USE ONLY SAMPLE i m NUMBER <br /> 2 ¢ OF <br /> LAB I.D. I.D. DATE TIME O m CON. <br /> O O TAIN RS <br /> E QUISHED Y SI ) DATEITIME RECEIVED BY SIGN DATE/TIME RECE VED FOR LABORATORY <br /> 1� BY(SIGN): C �.-L.>Ll.� DATEITIME /d <br /> RECEIVED: <br /> COLD AND INTACT OTHER PRESERVATIVE OYESy0 <br /> COTHER: <br /> TURN AROUND TIME: �x <br /> SHIPPED VIA: -FED X CUPS OTHER: SHIPPING ORDER NO.: 124-Hr C2-Day �5-Day X10-Day <br />