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CHAIN OF CUSTODY RECORD <br />,MPLERS: (Signature) I <br />SHIPPING INFORMATION <br />Phone: _ <br />SHIP TO: <br />ATTENTION: <br />Shipper <br />Address <br />Date Shipped_ <br />Shipment Service <br />Airbill No. <br />Cooler No. <br />Phone No. <br />Relinquished by: (Signature) <br />Received by: (Signature) Date/Time <br />Relinquished by: (Signature) Received by: (Signature) DatelTime <br />Relinquished by: (Signature) Received by: (Signature) Date/Time <br />Relinquished by: (Signature) Receive for laboratory by: (Signature) Date/Time . <br />Analysis laboratory should complete "sample condition upon receipt" section below, sign and return top copy to <br />Canonie Environmental Services, 83 W. March Lane, Stockton, Ca. 95207 <br />Sample Site Date Analysis Sample Condition <br />Number Identification Sampled Requested Upon Receipt <br />'%ice/o,l <br />White - Sampier <br />Canary - Return Copy To Shipper <br />Pink - Lab Copy <br />