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California Witter Labs <br /> P.0.BOX 4249 Client S�'2+`i C (2D�I 0430 CARPENTER LANE <br /> ii I MODESTO.CA USM2 Addces5 ori c_ <br /> P 10WE(209)527•4060 PhOne No.IL <br /> Contact person <br /> CHAIN OF CUSTODY RECORD (p404,pant) <br /> PROJECT NAME; jy <br /> 5-WLEKS (signature) :;a <br /> aluaber v �}• i� <br /> station <br /> Number!i Gate lime Itatica Locatloa can_ <br /> u u talncra <br /> 3 /ov <br /> 3 oF3 re2- <br /> J z c_ 3 <br /> z .p/ g 3 G3 G y <br /> 5JA raze, 53 <br /> � l 3 <br /> r - <br /> a, <br /> D - <br /> I RtiinquisAed by{signature): pate / Tine Received by (sigr;atune): Aelf <br /> nquittred Ly(zlyaaturn): pate / Time Raceivrd b <br /> Cogpany ar A�eacy: y (xiynat'I <br /> hl sky a Ageacy: as rrr• A9 :r t <br /> �Qa1P Y en <br /> `i {onpany or Ayeacy: _ <br /> i Relinquitbed by(signature): gate / Tlne Received by (signature); Relinquished 4Y: <br /> u ! Time Receives by (signator* •<' <br /> Company or Agency- Oaie Co1I Or Ayeucy: Company or Agency.. <br /> �.- <br /> i g y' Ccsp air or Ageucy; <br /> l RctiuQursbeQ by(signature): gate / Time Aceeived for L rotary by: Date <br /> 2 / Tia,e kpaerlcVshipping infomation - <br /> Cogparrr or Agencyr 'slyoure)n <br /> t <br /> i <br /> I - <br /> I <br />