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.) _ � w .�:N.• ...- _ Jif. _. ... _ <br /> California Water Labs <br /> P.o.BOX azas ClientbNt�oLIV f/N/f/L'D <br /> #, 1430 CARPENTER LANE U <br /> MODESTO,CA 95352 Address �7��f f/A/f /S/,w/dG <br /> PHONE(209)527•a050 Phone No. Yll <br /> Contact Person N&A' C4 0 ra A <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PR04IECT NAME: <br /> LINCOLN UN! FI I b S'CHUOL <br /> .h <br /> y^ �D <br /> SAMPLERS (signature) <br /> �G(r� Number T <br /> of REMARKS <br /> Station <br /> Number Date Time 9 2 Station Location tainers <br /> 7��4Y T,T/ V 17Y9 1100 1,y ui c, <br /> pomp. T/Wit n <br /> 1U,3° L/ �97a.3 <br /> roMP. mlijpCEw -:2— <br /> Relinquished <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: <br /> Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished b <br /> q Y: Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: <br /> // Company or Agency: <br /> Rel qg� by Si aTure): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Com any or Agency: 9�� (�Y� nature) 9/�� , <br /> � (_ �Sr `6 �I'M �fX 3 e sem' <br />