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California'Water Labs -� Co uiFs��eN s7zsNc <br /> P.O.sox 4249 Client U' <br /> 1430 CARPENTER LANE Address -� STo� <br /> MODESTO,CA 95352 Phone No. 5;-`f—96 5 3 <br /> PHONE(209)527-4050 5"' 77 <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: C) <br /> Seto <br /> SAMPLERS (si nat e) : Number <br /> v44-1% of <br /> 1- <br /> 4' /� 0 REMARKS <br /> �' � � 4 ev � mhh <br /> Station <br /> Number Date Time Station Location tamers <br /> VAOID �� 300 �,/�/ w. /[ rr+ rpt �y cA. P la <br /> nIP�E 1 So END t �\ <br /> �y <br /> .MWKa�j 3�?y .jg0 LF �-� MID LE X X 94' <br /> N 3� l�vw �t.35 s tf 3, soy tM) <br /> All <br /> TAN W(5) 1iB 4N MFLE X SAMPLES IS WA7£ <br /> RAVEL lScQN 1 <br /> �3 <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 /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Rel�pQy}shed ¢,�(�s�ig_nature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> i,}�Tvrl +Agency: <br /> 8 4 3 (signature) q <br /> Co�(�any or Agency: y� '• �' `�-�i I <br />