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California Water Labs <br /> P.O.BOX 4249 Client 5'EMC'U <br /> 1430 CARPENTER LANE <br /> MODESTO,CA 95352 Address 3/ Pg7CF/ fl) A0VtS>a e-Ll. <br /> PHONE(209)527-4050 Phone No. J'�4 —9G }3 <br /> CHAIN OF CUSTODY RECORD Contact Person S(-o <br /> (please print) <br /> PROJECT NAME: <br /> yy b <br /> SAMPLERS (signature) :j � <br /> Number <br /> FStation of v 4,n,L� v_ REMARKS <br /> Date Time E A Station Location ti y <br /> o <br /> � Con- <br /> tainers <br /> -W��b %>�M ✓ -<'?4 1'q Kk Fl ve - ten F�.t,r��i- <br /> SAM PIC 1( I\ t <br /> \ SAN,OLE <br /> _f 9 <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished liy(signature): Date <br /> / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: <br /> Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date <br /> / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: <br /> Company or Agency: <br /> Re 'nq�shegyb�ature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> (signature) <br /> mpany or Agency: <br />