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e 9 'F•�'� <br /> California Water Labs � � <br /> P.O.BOX L NOV 2 8 5989 Client <br /> � � , <br /> ' 1130 CARPENTERER LANE �S�3 <br /> MODESTO,CA 95352 ENVIRONMENTAL HEALTH Address <br /> PHONE)209)527-1050 PERMIT/SERVICES Phone No. --_--� sZf-- <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD (pleaseprnt) <br /> PRQJECT_tAME: <br /> q5T �S <br />� D <br /> RI <br /> (si a re) ryl� ► o `� t 1 <br /> Number r�Qi V <br /> of na REWWKS <br /> Station L ! W <br /> Number Date TimeCon- <br /> ' A Station Location tainers <br /> i 8 / 7"W <br /> s <br /> Relinquished by(signature): Date ! Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> i <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> C <br /> C <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> C <br />' - Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> - by r / Time Received yffoor Laboratory by: Datt/� / Time Remarks/ hipping `nformat ion _ <br /> L�^�pa or 9�9ey� / 2/?'r <br /> � <br /> (,sign � f <br /> (' f G�/ Oxy ' . Gtil� i r v S <br />