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' <br /> 417 <br /> HAIN OF CUSTODY RECORD Bill To � c <br /> 3 Wsc' Ivo <br /> 1951HSherwood 8471 N Lander Avenue C9 .� <br /> ilmar, <br /> PO Box 937 California 95324 <br /> Labs (249) 667-5258 Attentio Phone <br /> CORPORA T / ON FAX (209) 667-2581 .7 Page of <br /> Job Number PO # Project Name <br /> Samp (Signal e) Site Address �- 4� <br /> 7Mgo <br /> a C vG I ���' Oryp z zcyj <br /> SAMPLE LOCATION DATE TIME NUMBER E SAMPLE cr,} .Z <br /> (IDENTIFICATION) (MTH/DAYNR) (HOUR/MIN) OF (GRAB OR 91 <br /> ,t �� .r Q <br /> CONTAINERS COMPOSITE) MATRIX t � ,`e � REMARKS <br /> Cwmw— 11 10^ ` . 7 S fr ✓ ✓ <br /> ✓ ✓ v CIO E <br /> C7 ° IZ ✓ ✓ ✓ ✓ <br /> Crl,1 -� ,qp ✓ / ✓ s/ <br /> Z' ✓ ✓ r ✓ <br /> i <br /> Retinq hed By (Sig ure) Datefrime ReCerved By (Signature) Datefrime <br /> TURNAROUND TIME <br /> ,41 <br /> %h-uisheed/By (Sign re} DaefTi a 7e,, By (signature) D Eefri a 24 HOUR ❑ <br /> (/r to.� �/� a I 48 HOUR ❑ <br /> 6nquished By (Signature) O tern a Received By (Signature) Datefrime 5 DAY <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 />� r <br />