Laserfiche WebLink
California Water Labs L� o GMs <br /> P.O.BOX 4249 Client <br /> 1430 CARPENTER LANE Address "731 61 RCNwOoD !OD i < <br /> MODESTO,CA 95352 Phone No. <br /> PHONE(209)527-4050 LC d V p <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD (pies"print) <br /> PROJECT NAME: LLOYD GWA S � �, � V <br /> D <br /> . �e <br /> SAMPLERS (signature) Number tc1 r,4 <br /> of Cbl (C� �bdw-'� �' 041 i REMARKS <br /> Station � V h <br /> Number Date Time Station Location Con" <br /> tainers <br /> Ne#a l/ J SAMPt64411�-EAI t ENO. X "P— Loot SCA. <br /> 7ANKqNt `� 5,,j^pa Eas T-tND X �( x <br /> "Or V <br /> 77. 1 <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Rel <br /> qu had =,nature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> C ny or Agency: 4Sv (signature) <br /> L . /p Y PM 11 CA !orl <br /> C,cc% � i'�1U1'�'1 <br />