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California Water Labs �Li,� ceq <br /> m <br /> P.O.BOX 4249 Client <br /> 1430 CARPENTER LANE Address L�7` �/,X70 <br /> MODESTO,CA 95352 Phone No. 52 <br /> PHONE(209)527.4050 /f <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD �� (please print) <br /> I <br /> PROJECT NAME: <br /> o i <br /> G(N It <br /> 0 17(, <br /> AJ'W/( b <br /> SAMPLERS (signature)-: ,I f � �^�' s Number aa <br /> R.AARKS <br /> C h <br /> of <br /> �c Station <br /> Number Date Time b Station location tainers <br /> V C7 <br /> Z4 'gi V1 el' NIG SItN• E '! ' C ; <br /> / a <br /> to <br /> i <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> Company or Agency: Company or an <br /> Com A Company or Agency: Company or Agency: <br /> Agency:y' <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'nqur}hed� signature): Date / Time Received for Laboratory by: Date / Time Remdrks/Shipping Information i <br /> �L � (si nature) <br /> cCom�[t�y or gency: Z Z()'p, 1�x��i1�f � <br /> f <br />