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K� <br /> r <br /> i <br /> a <br /> .California Water Labs <br /> P.O.BOX 4249 Client e—'-r7 C p y <br /> 1430 CARPENTER LANE <br /> j MODESTO,CA 95352 Address <br /> PHONE(209)527.4050 Phone leo. 5oZ c� — S 3 <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: - <br /> u/► 2 fit/ ��n fr 1 ~"a = . y <br /> SAMPLERS (signature) <br /> Number V�mo <br /> of o^ U f a q <br /> / 4 REMARKS <br /> i � <br /> Station <br /> Number Date Time A Station :Lo:Cation Con- Ev <br /> u tainers <br /> sags,/ ex-,-Sr 53 <br /> J � <br /> J <br /> 6 <br /> I <br /> Relinquished by(signature): Date Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> ` Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature); <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency; <br /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time.. Remarks/Shipping Information <br /> Company or Agen y J L/ (signature) ) V. /3oej <br /> 31 <br /> swimi <br /> r <br />