Laserfiche WebLink
Client <br /> California r SAMPLE CHAIN OF CUSTODY RECORD Address � 2 � Vis«/n� <br /> Water Labs ,, / (please print) Phone No.g'� <br /> I 3 Proj. Mgr.IContact z o <br /> P.O. Box 4249 Ship samples to: Pink-Field Copy <br /> Modesto, CA 95352 1430 Carpenter Lane White and Yellow-To Laboratory with Samples <br /> (209) 527.4050 Modesto, CA 95351 Record of_ Yellow-Return to Client <br /> PI JECTISITE NAME: ANALYSIS REQUESTED <br /> PR OJECTICONTRACTIPO NO.: <br /> 7D �� yt <br /> ME MPL`fER: c REMARKS/SPECIAL INSTRUCTIONS <br /> LAB USE ONLY SAMPLE Mm NUMBER <br /> LAB I.D. I.D. DATE [IM U CON- <br /> TAINERS <br /> �9i�7o �Nr�z 9 X r�va:� feR%h�tcL ' a /� 1 ' <br /> FEB 6 i'22 <br /> ENVIRON",,=PdTP,L HFALTFi <br /> FER . <br /> LINQUISH BY (SIGN DATErrIME RECEIVED BY (SIGN) DATE/TIME RECEI D FOR LABORATORY <br /> /Z 4' BY(SIGk. DATE/TIME / <br /> 'Y 2 S fes, <br /> RECEIVE <br /> D AND INTACT OTHER PRESERVATIVE DYES ❑NO <br /> ❑OTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA:- ❑FED X ❑UPS ❑OTHER: SHIPPING ORDER NO.: 1124-Hr 112-Day [15-Day 10- y <br />