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Bill To,.- I <br /> 7o w!" <br /> 4"HAIN OF CUSTODY RECORD Cre W <br /> 11011,M. 8071 N Lander Avenue P, 0, 0 ox Z2 7,3,V <br /> anerwood PO Box 937 953 7 <br /> Hilmar, California 95324 <br /> FLSIJJ Labs (209) 667-5258 Attention Phone <br /> C 0 R P 0 R A T 1 0 N FAX (209) 667-2581 112,2 7 Page -1 of <br /> Job Number PO Project Name <br /> D 0�17 PC i )?U *"S� <br /> Sarnpl (Signalur Site Address ,16J <br /> X �� -�j <br /> �e (9 <br /> 77 -Q i,,,4 <br /> SAMPLE LOCATION DATE TIME NUMBER fYPE <br /> SAMPLE <br /> (IDENTIFICATION) (MTH/DAYNR) (HOUR/MIN) OF (GRAB OR <br /> CONTAINERS COMPOSITE) MATRIX Iq <br /> 'Zo REMARKS <br /> C - <br /> LJ <br /> J <br /> Relin h d By (Si Ka—fure) Date/Time Received By (S[gnature) Date/Time <br /> TURNAROUND TIME <br /> lure) <br /> 13Y (Signa Dfte/-rdne V Wecerve B (Sgnature) Dale/Time 7-.;Z 9 24 HOUR LJ <br /> co A-",n 48 HOUR Ll <br /> RAnquished By Signature) Date/Time Received By (Signature) Dale/Time 5 DAY 0' <br /> L-- <br /> DISTRIBUTION Original-Accompanies Shipment Canary Copy Sherwood Pink Copy Sampler NOTE Samples are 6scarded 30 days after results are reported unless other arrangements are made <br />