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x <br /> Y <br /> s California Water Labs <br /> ( N ERIN 5AgNOA v <br /> 00 a ' P.O.BOX ER L Address �yD 3 H Y - STo c xTo <br /> 2 U 1430 CARPENTER LANE w <br /> e J r MODESTO,CA 95352 (,�(D 4 ' '75 08' <br /> 1� CV PHONE(209)527-4050 Phone No. <br /> P ca Z Contact Person ERv/N 5%1 N PA(J <br /> UJ <br /> Us CHAIN OF CUSTODY RECORD (please print) <br /> tied"Y <br /> •' PROICT NAME: 0 C <br /> G o w ERv�ti s>4NflA � � <br /> ^N <br /> r SAMPLERS (signature) <br /> n O n/uC� Number REMARKS <br /> Station O\/�M�e_„•.'� ,.L7 vQJ �4e <br /> Number Date Time o ro Station Location tainers �� V <br /> u co <br /> yU9 NwY f Sl�rk7a N I �.� <br /> 8�8 SA n P«° L t X/ S G1 <br /> ��4Y l�od n f%$# a rte t D Dc e ! J U <br /> i <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 /> ( <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency. <br /> Y: <br /> t <br /> Reli ins Fyted by( 'gnature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> C <br /> Comp (7 Agency: y �,(�j (signature) Q/8/ <br /> //Pin hpu.0 �h.BY�-YL y 85 P <br />