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California Water Labs Client(3ASSETT �o>JW�1a� <br /> P.o.eox alae <br /> 1430 CARPENTER LANE Address 7730 t;REfN RIbGF�ff�l�i O/f(�S C-FI. <br /> MODESTO,CA 95352 Phone No«�6 <br /> PHONE(209)527-4050 <br /> Contact Person �REX <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: 6q SSC // ro/,J57-Rv,�-T�o/o J/ ,Illi <br /> 15E/L <br /> SAMPLERS (signature) Number ( ?° z �P <br /> of �'yG\ L\ REMARKS <br /> StationC' I��G • <br /> on- <br /> Number Date Time E Station Location taCners <br /> u <br /> ( 1/ ,3a et) ✓0 0 W G 7H 5-1. <br /> m ✓ 74117P1f#( 5vV7H END SALVER US� <br /> • <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Rel ' quashed by 'gnajure): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> 2+A �/ 534 (signature) <br /> COany or Agency: / l- <br /> c w L . �yY pr1 r T rot <br />