Laserfiche WebLink
i <br /> lent <br /> calftmiaSAMPLE CHAIN.OF CUSTODY RECORD Address �i <br /> \ \ ����� (please print) <br /> phony No. 3-5 <br /> Pro).Mgr.(Contact Z 'n'1�`� --- ' <br /> ,I 0360 <br /> { Pink•Field Copy <br /> P.O.Bax 4249 Ship samples to: White and Yellow•To Laboratory with Samples <br /> Modesto,CA 95352 1434 Carpenter Lane Record of Yellow-Retnm to Ctlent <br /> {209}527.4050 Modesto,CA 95351 r <br /> PANALYSIS REQUESTED <br /> ROJECTlSITE NAME: <br /> PROJECTfC N <br /> TRACTIPO No.: <br /> REMARKSISPECIAL INSTRUCTIONS u ` <br /> NAME,OF SAMPLER: <br /> LAB USE ONLY SAMP NUMBER <br /> � Q 'C -DATE TIME I.D. N ¢ t <br /> INERS <br /> I A VIED FOR LABORATORY <br /> DATEIfIME RECEIVED BY SIGN OATFJTIMi; a <br /> i... <br /> RELINQUISHED BY ,s- .a-� <br /> R 8Y(SIGN): �'r.�t DATEliIME <br /> RECEIVED: <br /> )5COLD AND INTACT OTHER PRESERVATIVE 0Y;SNO <br /> n � <br /> ❑OTHER: <br /> TURN AROUND TIME; <br /> t= � SHIPPING ORDER NO.: <br /> 024-Hr �2•Day 05•Day 010-Day <br /> S141PPF-D VIA: FED X ❑UP5 LIDWHEA: ' <br /> 111 f <br /> k� <br />