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1 <br /> ... <br /> tModesto, <br /> SAMPLE CHAIN OP CUSTODY RECORDCalftmicaAddress(please print) Ptfone Nod V�cder�abs Pro].m9ficontact <br /> �o <br /> Pink Field CopyP.O.Box 4249 Ship Samples to: VYhlte and YellowTo Laboratory with Samples <br /> OA 95352 1430 Carpenter Lane Record of Yellow-Retum to Ghent <br /> (209)527.4050 Modesto.CA 95351 <br /> ANALYSIS REQUESTED <br /> PROJECTMITE NAME: D <br /> �C <br /> PROJECTICONTRACTIPO KO.' <br /> REMARKSISPECIAL INSTRUCTIONS q , <br /> NAME OF SAMPLER: f <br /> LAB USE ONLY k LE m, NUMBEROF <br /> ' <br /> I.D. 1.D. DATE TIME o CON- <br /> LAB- - O Z) WNERS ' <br /> I 1�j <br /> a <br /> i, <br /> ,1 <br /> RECEIVED BY SIGN DATEJTIME RECEIV D FOR LASOAATORY ; <br /> RELINQUISHED aIY SIGN DAT ME �///� - <br /> ' tt { y QD /1 iS/�i /Z� DY tSIGN): t]ATEITIME(t r a <br /> 1 1 N <br /> RECEIVED: <br /> 06LO ANn"fTACT OTHER PRESERVATIVE DYES Ef0 �. <br /> DOTHER: ' <br /> TURN AROUND TIME:, <br /> ER NO.,.- E)24-Kr 02-DaY 05•DaY <br /> AD-Day <br /> 8 <br /> SHIPPED VIA: pFED?C lOUPS .ESpTHER. SHIPPING ORD •I <br /> f <br /> l <br /> r <br /> f � <br />