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N <br /> V <br /> " California Water Labs EXU <br /> P.o. BOX 4249 Client <br /> 1430 CARPENTER LANE Address <br /> MODESTO,CA 95352 Phone No. <br /> PHONE(209)527.4050 <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: 9 '.`'a°"v <br /> G 5 e a/"—A (h �Uv '.✓ <br /> ,> <br /> SAMPLER (S gnature) a P <br /> /y (. l Number Q°moi / [r, REMARKS <br /> 7 / w. o f y aMr <br /> Station / C �\� t+s <br /> Number Date Time ? Con- <br /> Station Location tainers �) <br /> V U' <br /> U 9 <br /> Al- I 1 v <br /> I x <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): DaTTimeReceived <br /> by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Daby (signature): <br /> Company or Agency: Company or Agency: Company or Agency: por Agency: <br /> Relina�utpsh dyy si Ra re),) Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> pay Agency; ✓ (si nature) 2' <br />