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Gdlifornia Water Labs <br /> 4 <br /> P.o.Box 4249 e- <br /> Client_ � E'rYl< <; <br /> 1430 CARPENTER LANE A <br /> MODESTO,CA 95352 Address I/ Z't-j i7�xa'-C"Ar <br /> PHONE(209)527-4050 Phone No. S Z 1�c S3 �— r3 J-7 <br /> CHAIN OF CUSTODY RECORD Contact Person r� c <br /> as <br /> print) <br /> PROJECT NAME: <br /> -o: <br /> S RS (signature) ; <br /> C Number ���� i aiC <br /> 1' REMARKS <br /> Station / <br /> Number Oate lime E b Station Location Con- <br /> tainers <br /> 7 3a \ <br /> X X F <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date <br /> / 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 by: Date / Time Received by (signature): <br /> Company or Agency: <br /> Company or Agency: Company or Agency: <br /> Company or Agency: <br /> �ntqu/Ii����,�LiC: Dat / Time Received for Laboratory by: Date / Time Remarks/Shi`'�l� � pping Information <br /> mp ny or7 (signature) tSP`�bloelmPU41W9 <br />