Laserfiche WebLink
California Water Labs <br /> P.o.sox 4249 ClientrnULLL{� SUJ�P2y <br /> 1430 CARPENTER LANE Addressy/� S. swefi'11KENr6 ST Cio/,i) <br /> MODESTO,CA 95352 - Phone PlO. -3'314 37�/ <br /> PHONE(209)527-4050 - <br /> Contact Person V l(Z Ci ! +J I A <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: MU4LE rAI� 5L/ 1_/PpL�/ n� <br /> I <br /> SAMPLERS (signat e) r Number Q�Q°' Lbb <br /> � ¢ of TL ` REMARKS <br /> StationCon- <br /> Number Date Time o b Station Location tainers <br /> a -Sy U U <br /> g - 11ya� 91D. S. SAtRAn.EMY-o r 1 I <br /> SAMPLE UJ Mi oto I a - Cos <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 /> Reli ul ed bypr��.�i gnature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> W1 �&CqL' F �� (signature) <br /> Coy or Agency: �� <br /> �wL � �� <br />