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HAIIV ®A�C <br /> CMUSTO®Y RELs0R® Ill""'To SHERWOOD LABS <br /> PO BOX 937 <br /> Sher8071 N Lander Avenue HILMAR, CA 95324 <br /> PO Bax 937 <br /> 1511 Labs Hilmar, California 95324 <br /> (209) 667-5258 Attention Ph <br /> C O R P O R A T I O N FAX (209) 667-2581 VICKI HUB1S one 209-667-5258 Page of !" <br /> Job Number PO 0 Protect Name <br /> Samplers (Signature) Site Address <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE <br /> (IDENTIFICATION) (MTH/DAYNR) (HOUR/MIN) OF (GRAB OR MATRIX <br /> CONTAINERS COMPOSITE) REMARKS <br /> {t r r <br /> Fa" 8 5 s e <br /> t r r t <br /> Relinquished By (Signature) Date/Time Received By (Signature} Date/Time TURNAROUND TIME <br /> Relinquished By,(Signature) DateMme _ Received By (Signature) t' DateRme 24 HOUR ❑ <br /> 48 HOU,9-0 <br /> Relinquished By (Signature) Daterrime Received By (Signature) 4 Datemme y <br /> 1, 5 DAY EX, <br /> DISTRIBUTION Onginat-Accompanies Shipment Canary Copy Sherwood Pink Copy Sampler NOTE Samples are discarded 30 days after results are reported L <br /> unless other arrangements are made <br />