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TIM h1T <br /> 'RAIN QSTODY RECORD se, <br /> Jl <br /> Sher:ood P01Box 937 Lander Avenue <br /> U <br /> Hilmar, California 95324 <br /> Labs (209) 667-5258 AttentionPh <br /> C O R P O R A T I O N FAX (209) 667-2581 5-7 f c1 � �j 0 Page 1 of / <br /> Job Number PO # Project Name p 1 <br /> Inn" ,tea <br /> Samplers (Signature) _ ® Site Address �Gj� 01 AA 40 <br /> ISAMPLE <br /> 4thiPLE LOCATION DATE TIME NUMBER TYPE } <br /> SA �a .r <br /> (ID (MTHIDAYIYR) (HOUR/MIN) OF (GRAB OR 2 <br /> CONTAINERS COMPOSrrE) MATRIX ,`Q ,�� REMARKS <br /> Gr- so ( / X <br /> M-l03 .a.-;X- <br /> 3 - o <br /> '11115/03 1Y V <br /> F <br /> Relinquished By (Signature) Datefl-ime Received By (Signature) Daterrime TURNAROUND TIME <br /> ���(�3 , /�.3�J /�l �f/y U 3 �G?4 <br /> Relinquished By (Signature) DateMme Received By (Signature) Dateffime 24 HOUR ❑ <br /> 48 HOUR ❑ <br /> R lglquished By (Signal (e) DatelTime �' v terve By (Signature) Date�me Tj DA <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 />