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California Water LabsClient PmlAseoplellal4i� v4n/%A <br /> P.O.BOX 4249 <br /> �ar ' 0 CARPENTER LANE Address 07 SCLC t� .��r <br /> t ODESTO,CA 95352 103-77Y3 Ys <br /> CJl! OCT 17 HON E(209)527-4050 Phone No. Fe- en <br /> /3(J� 3 1989 Contact Person — <br /> t�`�'i CHAIN OF CUSTODY RECORD (please print) <br /> PRO,�Et1S NAME: <br /> STK-ERI <br /> (�siDgnature Number Q°Pv� <br /> of (�(,�� �1„ REMARKS <br /> Station a a Con- <br /> Number Date Time R Station Location tainers <br /> u � <br /> X <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 /> Rel' shed y gn e) Dae / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> /p <br /> vh-�Ot /6� (sigryaturej� L <br /> mpany o��r��ency:� 7_ 7!° l+/L/j/ Jl � /\�c c( Cpr�� f ivi a( <br />