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1 <br /> 'California Water Labs <br /> P.0.BOX 4249Client U' <br /> a <br /> 1430 CARPENTER LANE Address <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 Phone No. 44 <br /> Contact Person ,r4l-T <br /> CHAIN OF CUSTODY RECORD (please print) <br /> cn <br /> PROJECT NAME: c, <br /> P R5 (sig ature <br /> ,1 c Number 4° <br /> of REMARKS <br /> I stat n S91" C-0 <br /> Nx`wer Date Time E n Station Location Con' I `.� f?G1_ l404 <br /> ,, tainers �V a / / <br /> ✓ <br /> )I' !S k 1v0 C1nrdE s{ rfr 7X??7 �' � a <br /> i 3 <br /> IG' O" MAO <br /> f�= <br /> Ceinquished by(signature): Date / Time Received b g ) q y( g ): / Time Received by (signature): <br /> y {5i nature Reiin ulshed 6 si nature Daley or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> R <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: Company or ency.- Company or Agency: Company or Agency: <br /> R nqui shed by(signature): Date / Time Received for Laboratory by: ate / Time Remarks/Shipping Information / <br /> C P Y o s to ] /p.LY� �A 76Erol C,(s <br /> Sib^a <br /> i <br />