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California Water Labs <br /> P.O.BOX 4249 Client L/NrDLN VNlr/LD ScN�GL <br /> 1430 CARPENTER LANE <br /> MODESTO,CA 95352 Address <br /> PHONE(209)527.4050 Phone No. <br /> Contact Person MCA" C'<A%Tai <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PR04ECT NAME: <br /> LINcvW UNI �i E"� ScHvo� <br /> ' D <br /> SAMPLERS (signature)6 c J <br /> Number Q <br /> of REMARKS <br /> Station <br /> Number Date Time r Station Location Cofi- <br /> tainers <br /> yI��FY ��•l� V 7y9 H 1 �s U/ f. <br /> C-0,14A S'H,MPIt <br /> i/ roM P. M1fj Pk e $j Z l <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 nq fished by�6i azure): Date / Time Received for Laboratory by: Date / Time& Remarks/Shipping Information <br /> Company or Agency: % �� nature) `�I� <br /> �w L i 8 8 _ .�- 3 <br />