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I . 'I <br /> A <br /> I <br /> p� <br /> 6 <br /> L <br /> California Water Labs <br /> P.0.BOX 4249 Chant <br /> 1430 CARPENTER LANE Address - <br /> MODESTO,CA 95352 few tf_ 1`G j 3 u <br /> PHONE(209)527-4050 Phone No. <br /> Contact Person,� G <br /> CHAIN OF CUSTODY RECORD (please print) <br /> Nati I <br /> PROJECT NAME; $ <br /> 12a <br /> SAMPLERS (signature) <br /> Nuzber Q e� <br /> of REMARKS <br /> Station s=' <br /> Number Date Time L Station Location Con- <br /> tamers <br /> V U <br /> r52-J <br /> y5" <br /> h-/3 e 3 <br /> y� <br /> z3 ov <br /> I <br /> Relinquished 6 si nature): Date / Time Received b <br /> y( g y (signature): Relinquished by{signature}: Date / Time deceived by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Tide RecLlYp� by (signature): Relinquished b Date / Time Received b <br /> I 9 ): 4 Y: y {signature}: I <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by <br /> (signature): Date / Time Receiveu for laboratory by: Date / Time Remarks/Shipping Information <br /> sigrraturci %e �. . <br /> i <br />