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Clientc �co,� Ccwr <br /> California SAMPLE CHAIN OF CUSTODY RECORD Address <br /> kModesto, <br /> Water Labs r (please prim) Phone No. <br /> Proj. Mgr./Contact <br /> FEB 215150 100 ' <br /> P.O. Box 4249 Ship samples to: , T�E HE `! j Pink-Field Copy <br /> CA 95352 1430 Carpent�et.WOIRON M�'`� I+ _ / White and Yellow-To Laboratory with Samples <br /> (209)527.4050 Modesto, CA 9535 -i :;Record of Yellow-Return to Client <br /> PEYRN*J1 , <br /> PROJECTISITE NAME ANALYSIS REQUESTED <br /> PROJECTICONTRACTIPO NO.: e <br /> 4a7?gs 9 C� S , �✓ <br /> , AME OF SAMPLER: r.\� REMARKSISPECIAL INSTRUCTIONS <br /> LAB US ONLY 5 E 0 < NUMBER Q <br /> OF <br /> LAB I.D. I.D. DATE TIME O ¢ GON- <br /> D O TAINERS <br /> 91"" <br /> ZL Le 7- S' 3ai k <br /> 0 <br /> RELINQUISH7UPSEO3 <br /> TIME RECEBGN DATEITIME RECEIVED FOR LABORATORY <br /> �9BY(SIGN): Y- DATE/TIMERECEIVED: <br /> /) OLD AND INTACT OTHER PRESERVATIVE ❑YES ❑NO <br /> ❑OTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA: ❑ R NO.: ❑24Hr 112-Day 05-Day <br /> `&1D-Day <br />