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California Water Labs <br /> P.O. BOX 4249 Client — <br /> 1430CARPENTERLANE Address �0� <br /> MODESTO,CA 95352 phone No. � — S 3 <br /> PHONE(209)527-4050 r <br /> Contact Person '),1 f r <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: <br /> 5AMPLERS (signature) : Number a°P�^ G D v SEP 6 1989 <br /> ��1 \ REMARKS <br /> of _ <br /> ENVIRON' 7NiAL FIEA_ <br /> Station on-- Con- G pFt?pnrr!cr-RN!CF^ <br /> 1 Number Date Time ? Station Location to A <br /> u w <br /> 7- /c 'me q T <br /> 123 <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: Late / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> (signature) <br /> Company or Aggncy: <br />