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Bill To: <br /> AIN OF CUSTODY RECORD . ..... <br /> 8071 N. Lander Avenue <br /> Sherwood P.O. Box 937 <br /> Hilmar, California 95324 <br /> Labs (209) 667-5258 ——— Phone: <br /> C 0 R P 0 R A T 1 0 N FAX (209) 667-2581 1 7-:2 5 5 Page I o <br /> f f <br /> Job Number- Project Name <br /> Samplers:(Signature) P.O.Number: <br /> SAMPLE 'SAMPLE NO. A <br /> DATE TIME SAMPLE INFORMATION OF 1 REMARKS <br /> NUMBER TYPE CNTRS <br /> Wafer X X <br /> yl_ <br /> 9070 <br /> -77 <br /> 'T <br /> Sol-( <br /> A <br /> 70 151 1507' '11 <br /> 13 , 50-1 <br /> R 1, ASj,�nature) DateCrime, Received By:(SignatLi1e)_,,, Dat /T' Ship Via: <br /> _;�ed By "10 ZZ— <br /> Relinquished by:(Signature) DaterTime (signature) Date/Time <br /> TURNAROUND TIME: Date <br /> Relinquished By:(Signature) Date/Time Received By:(Signature) Date/Time ❑24-HR )d 5-Day ❑10-Day <br /> DISTRIBUTION Original-Accompanies Shipment: Canary Copy-Sherwood Pink-Sampler NOTE:Samples are discarded 30 days after results are reported unless other arrangements are made. <br />