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California Watel Labs <br /> P.o.eox 4249 Client 1)7AZ Z E RA 5 1/vc ' <br /> 1430 CARPENTER LANE Address <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 Phone No. <br /> ContactILL Person MC 55 (cl< <br /> CHAIN OF CUSTODY RECORD (please print) " <br /> PROJECT NAME: /nA ZZt Q A a LN C �ESlE13N <br /> o� <br /> mete y"�D ('� 'V <br /> SAMPLERS (signature) 0 Number V4? a �O <br /> REMARKS <br /> StationCon <br /> p a _ <br /> Number Date Time N C Station Location / / 1 <br /> tainers <br /> Al t/ snnnPcett�l� �t COniTAINE � IS <br /> qj EpRA SOIL. (NO ODoR) <br /> I <br /> u <br /> At <br /> 0 <br /> 0 <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 /> 6' <br /> Rel' shed y(skgnature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> CoApany or Agency: <br /> S/ /.2.35 (signature) <br /> C wL j5�9f1 ��, 7'3g? <br />