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California Water Labs <br /> P.O.BOX 4249 L' Client <br /> 1430 CARPENTER LANE Address 73 1 ' o-n-f n uO <br /> MODESTO,CA 95352 ; <br /> PHONE(209)527.4050 Phone No. 92%-22t2_7 S �, �fS3 4 <br /> C ntact Person--tzr�cl/J <br /> CI4AIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: <br /> At Lime, <br /> SAMPL S ignature <br /> Number N �a REMARKS <br /> of <br /> Stat on o a Con- <br /> Number Date Time Station Location - '�I.. -' <br /> It)VO X A 'tlf <br /> C,)I.✓ <br /> .��i D�fa✓U <br /> I <br /> h <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 /> --- -- <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency:— <br /> R n�d ;ign ure): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> 4 Pany or gy. � �i� /1 t9n�r�r� Vt,def <y <br />