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California Water Labs FraafQ9 <br /> P.O.Box 4249 Client1430 CARPENTER LANE Address 33() KC T T«�� Lon1 <br /> V1 <br /> MODESTO,CA 95352 J6 1989 Zo y •73 y c�txl� <br /> PHONE(209)527-4050 Phone No. �A-n. 1 <br /> ENVIRON sENTAL HEALTH Contaci Person �/ <br /> CHAINPIWGUSMTERECORD (please print) <br /> PROJECT6 NAME: <br /> SAMPLERS (signat e) v <br /> — NumberQ°Q°' x\/ <br /> REMARKS <br /> of <br /> Station Con- <br /> Number Date Time A Station Location tainers X <br /> C <br /> 36 l-1 h neo F. K `Tri m Li 4-STc- 01 L- TA-4 <br /> a <br /> linq shed b sig ture): Date / T'rme Re ved by (si gnatu a Relinquished by(signature).- <br /> 11-16-5Y <br /> e): Date / Time Received by (signature): <br /> /i/6 5`6 �' <br /> C puny, ge Co pa cr g4n Y. <br /> Company or Agency: j Company or Agency: <br /> I <br /> Relinquished by(signature): Date / T,me Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Rp.l,iQtsh d b (si natur Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Cum`. ay r A e,�c 1f-16-Y'� (signatur <br />