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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 /> CHAIN OF CUSTODY RECORD <br /> PROJECT NAME: <br /> ^y D <br /> SAMPLERS (signature) c o <br /> Number Q <br /> of REMARKS <br /> Station <br /> Number Date Time c Station Location Con-. <br /> tainers <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 /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Company or Agency: (signature) <br />