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Tom'F <br /> ATERWOR <br /> CHAIN-QF-CUSTODY RECoK. AND ANALYSIS REQUEST � <br /> PROD.NO. PROJECT NAME ANALYSIS TYPE REQUESTED <br /> 19 wE of ssroE* T <br /> SAMPLERS:(Signature) = LU <br /> W <br /> rA rc <br /> u, <br /> IL 0 a <br /> E.D.NO. DATE TIME0 STATION&LOCATION <br /> U Ory a cn REMARKS <br /> 4 J5 ✓ ✓ rY! An l <br /> W Z Lou. 11wol ii I Jvlyl77,0_40MQ ,} <br /> 3 !D la /I I1 � are x <br /> PLEASE RETURN ICE CHESTS <br /> AND BLUE ICE TO WATEFfWORK 4 <br /> °ft`PR ohMGR <br /> Relinquished by: Date Time Received by: Relinquished by: Date Time Received by <br /> f ! <br /> -Glut/ <br /> 9-011 D00 , <br /> Relinquished by. Date Time Receiv by. Relinquished by. Date Time Received by. <br /> i <br /> Relinquished by. D Time Received by Laborato Date Time REMARKS(Shipping Related): <br /> t i <br /> ,,11 <br /> R�e1 L�A� <br /> 1710 MAIM S7REEf • ESCALON,CA 95320 6 (204) 838-3507 <br />