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California Water Labs <br /> P.0.BOX 4249 ClientMAz. rn9NAGCrr `tiT <br /> 1430 CARPENTER LANE AddreSS Z/s Al FI/V6 RO- <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 Phone No. 3,S 31 <br /> Contact Person Df1LE CAglpinAI <br /> CHAIN OF CUSTODY RECORD (please print) <br /> .M,1 A,4 G 6.+a tyli <br /> PROJECT NAME:/h A.t• ki���-8- �, h <br /> /V <br /> wESJE7QAy ETEn ��M^e� V <br /> SAMPLERS (signature), ° <br /> Number QI <br /> of REMARKS`G <br /> Station <br /> Number Date Time o b Station Location Con- <br /> tainers <br /> U U' <br /> —7-7772360 I?D <br /> iANK�I 7�7/ LP54li?PZ #(l> sooJHEUd 1 X VgFS9/r1G<< �'tik (lJ <br /> NI 7�f f• J �/ 7.3003 1 4 6b . <br /> SA »9L 3 SovT t v0 lx RIC5AIA7P/ TAIti/r 3 <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 /> R;I'nnq/gyshed by signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> P 'f�N ZC�—� 7�� y,3d ignature) / <br /> C pang or Agency: J 1, " <br />