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California Water Labs, Inc. <br /> P.O.BOX 4249 <br /> 1430 CARPENTER LANE—SUITE G <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 <br /> D CHAIN OF CUSTODY RECORD <br /> PROJECT NAME: JTOCk -rt) yF) T-CN CL L) <br /> w�SrEx Ai nn� TE%1 <br /> SAMPLERS (signature) <br /> ,f Number QCQz REMARKS <br /> r✓Yl /LGC.a- of <br /> Station d a Con- <br /> Number Date Time o i Station Location tainers <br /> TAS <br /> S .= <br /> Relinq .!shed (signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> gilr <br /> Comany 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 /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Company or Agency: (signature) `J <br /> if � <br />