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California Water Labs <br /> P-O.BOX 4249 Ciient <br /> 1430 CARPENTER LAWE Address V 3 <br /> MODESTO.CA 45352 7-e-4A y <br /> 4 PHON E OM 527-40W Phone No. <br /> Contact Person '' <br /> CHAIN OF CUSTODY RECORD (Please Pnnti <br /> PROJECT tW E: <br /> ' <br /> SAMPLERS (signature) : 1 � <br /> • ' REMARKS . <br /> of <br /> ststlon ` V <br /> number Date Tick Station Location16 <br /> tart <br /> ��z .3z neo s ;`�•oST 1 <br /> X600 <br /> -» I o <br /> 1- �o fico •mss /f CST <br /> 03 <br /> VA v� Jt ea o�. QS <br /> EI <br /> Sd,� ,/£ /!pit?�— / 0.6 <br /> r) "0 5e:I :/t SovT j,. / <br /> D CallaWished by(signature): Date / Me Received by (sipatdrt): Reiiaquisbed by(signatura): Date / Me Received by (sigostdre): <br /> n <br /> Ca�any or Agency: CompmV or Agency: C�any or Agency: Co�any ar Agency- <br /> 0 <br /> RelinWished by(signature): date / Tt=e Received by {signature): Relinquished by: Date ! Tire Received by (signature): <br /> V Company or Agency: Company or Agency: tonspany or Agency: Company or Agency: <br /> Cetinpuished by(signature): gate j Time Received !or Laboratory by: Date / Time Remarks/Shipping Information <br /> 57, 9r Y <br />