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40HAIN OF CUSTODY RECORD Bill To <br /> L� e rev 1 rte' <br /> F W 3y�50 rL C� ,rnfv <br /> Sherwood8071 N Lander Avenue �0 7 <br /> PO Box 937 CC' cg , <br /> Hilmar, California 95324 <br /> Labs (209) 667-5258 Attention �� Phon1 <br /> C O R P O R A T I O N FAX(209) 667-2581 f 153 <br /> 7_07 7 Page of t{ <br /> Job Number O # Project Namd f <br /> N9, pC+ems <br /> Sam rs (Signature) Site Address <br /> 749 <br /> � y � <br /> SAMPLE LOCATION DATE TIME NUMBER PE SAMPLE 41 <br /> (IDENTIFICATION) (MTH/DAYNR) (HOUR/MIN) of (GRAB OR MATRIX '�� Q� I <br /> q �1 CONTAINERS COMPOSITE) � t1` REMARKS <br /> 6Y4i3 f J«tr ✓ ✓ <br /> aLv4 7 35,4w; ' ✓ <br /> CL.L wt w- -7 D` <br /> f31 <br /> C 4a,I.,'►vv'I K w- <br /> Relqui —B-y�(Signatu ZDen aD3 te5m1 mYeHn <br /> Recelved By (Signature) '. .r Date��s <br /> me <br /> TURNAROUND TIME <br /> 1r p �/, // rrt ? <br /> Jr <br /> R quashed By (Signature) D t rme W cew By (Signature) _ Dateliime 24 HOUR ❑ <br /> y Il.�y� �fr�arP1� ��l, � u 5 `f�r1�7 48 HOUR El <br /> irnquished By (Signature) Datetrime Received By (Signature) DateTime 5 DAY U-O'— <br /> DISTRIBUTION original Accompanies Shipment Canary Copy Sherwood Pink Copy Sampler NOTE Samples are discarded 30 days after results are reported unless other arrangements are made <br />