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., . sem:j3a t•4 i' v � fac ri �vs ems. Y <br /> California Water Labs <br /> P.o.aox alas <br /> Client <br /> 1430 CARPENTER(LANEP,-Ir 51/22 <br /> Address 1�,� �'� <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 Phone No. <br /> Contact Person ' '�Prl 7- <br /> CHAIN <br /> CHAIN OF CUSTODY RECORD (plesse Tint) <br /> PROJECT NAME: <br /> zU <br /> SAMPLERS (signator ) !lumber Qc W <br /> 7 K of cv LU CIO REMARKS <br /> Con- <br /> Station — = . <br /> Number Date Time a Station Location tainers o <br /> LJ Of <br /> ,r v � <br /> Relinquished y. signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> .�/ / i � 'rte-_ hal- <br /> Company o� cy: Company or Agency: Company or Agency: Company or Agency: <br /> Re)i nquished by(signature): trate / 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 /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> (signature) , r �n <br /> C ' ny or Agency: J/ 'I f�.U� P� Ct,' !! <br /> o <br /> �� <br />