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Client ' <br /> California SAMPLE CHAIN OF CUSTODY RECORD Address L <br /> I Water Labs (please print) Phone 14#0V-3/v <br /> 0047 Proj. Mgr./Contact Rud b <br /> L I P.O. Box 4249 Ship samples to: <br /> Modesto, CA 95352 1430 Carpenter Lane <br /> Pink Field Copy <br /> (209)527-4050 Modesto, CA 95351 Record _ of_ White and Yellow To Laboratory with Samples <br /> Yellow-Return to Client <br /> PROJECT/SITE NAME: -� <br /> moo\ ANALYSIS REQUESTED <br /> Y/le LRne �. ^th <br /> PROJECT/CONTRACT/PO NO.: <br /> 0 10 <br /> NAME OF SAM^PLEgR: <br /> D. /�pu f //�' `( X REMARKS/SPECIAL INSTRUCTIONS <br /> LAB USE ONLY SAMPLE u m NUMBER <br /> LAB I.D. 1,D. DATE TIME O CON- <br /> 0 TAINERS <br /> Q6R6D Aio,kl a-A /(,z X ( v <br /> 61 Soulj 104 //:/y X r X u <br /> RELINO SHED 8 IGN) DATE/TIME RECEIVED BY (SIGN) DATE/TIME RECEIVED FOR ABORATORY _/ <br /> BY(SIG 10_y�--rCn.- DATETIME <br /> RECEIVED: <br /> CCOLD AND INTACT OTHER PRESERVATIVE EYES ENO <br /> EOTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA: --FED X --UPS --OTHER: SHIPPING ORDER NO.: �24-Hr E2-Day E5 Day C10 Day <br />