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California Water Labs <br /> P.O.BOX 4249 Client I N` �L nl (SNI/-/C n <br /> 1430 CARPENTER LANE <br /> MODESTO,CA 95352 Addres� _ <br /> PHONE(209)527-4050 Phone No. 1/7 3 5 9 5— <br /> Contact Person -7 L N� <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: <br /> LlNc�yN (JfJI � I-�� �CNoDL , <br /> h y <br /> SrPLERS (signature) , (/ q��� �o p <br /> — 1 Number 1 � \C �'r <br /> / of �l 1, RE <br /> } MARKS <br /> Station � ••, <br /> Number Date Time u Station Location Con- <br /> tainers <br /> �Q v <br /> � la>d v Cv`i�ty }.fAr R�sC3U}QG <br /> gy rt >�ntPt c tl 1-� w wtsT CN9 <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 /> I <br /> Rel ,i� ui}l,ed byjgnature): Date / Time Received for Laboratory b Date iiy y: / Time Remarks/Shipping information <br /> Cui an or A enc ( iy J signature) �.� <br /> Y 9 y: / l'y L• ! <br />