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CHAIN OF CUSTODY RECORD Bill To SHERWOOD LABS <br /> P O BOX 937 <br /> Sherwood <br /> ���®� 8071 N Lander Avenue HiLMAR, CA 95324 <br /> PO Box 937 <br /> 7Ar <br /> Hilmar, Call#omia 95324 <br /> Labs (209) 667-5258 Anent,on VICKI HUBIS Ptane 209-667-5258 Page Olt <br /> C O R P O R A T 1 0 N FAX(209) 667-2581 <br /> Job Number PO # Protect Name <br /> CARDOZA SUPER STOP10 <br /> v <br /> Samplers (Signature) Site Address <br /> 4. <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLEOF (GRAB ORMATRIX REMARKS <br /> (IDENTIFICATION) (MTHIDAYIvR) (HOURIMIN) CONTAINERS COMPOSITE) j <br /> 8--I8-04 c ✓ <br /> MW--1 VV0111- <br /> i <br /> t Dated e <br /> DateRme ived y,(Signature r TURNAROUND TI <br /> Rellnq fished Signatur <br /> S ME <br /> _ 0-0 III J <br /> Relinquss d (Signawre} DatefT)me <br /> ece (Sign re) Dat ime 24 HOUR ❑ <br /> 48 HOUR ❑ <br /> Dat me AY <br /> RelcnquE ed By (Signature) DateMme <br /> Re ve y (Signature) <br /> 1 15TRlBUTION Original Arxompmes Shipment Canary copy Sherwood Pink Copy Sampler NOTE Samples are discarded 30 days atter results are reported unless other arrangements are made <br /> I <br />