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I <br /> I <br /> CHAIN OF CUSTODY RECORD WTO <br /> c" PO Bax 937 <br /> 4= Affil mod PO Box an&r Avenue <br /> o8071 N <br /> Labs <br /> Hilmar, California 95324 <br /> (209)667-5258 <br /> CORPORA TI ON FAX(209)667 2581 1 <br /> Anenucn Phone <br /> VICKI HCBI Page <br /> Job Humber PO # P ecl Nama <br /> q �plars (Signature) Site RddnassG� ����'� �y � �h�1 � q <br /> L <br /> Q SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE <br /> LO iIDENTIFICATION) (AITWDAYNFI) (HOURWIN) OF (GRAB OR A. QZ' <br /> CL c>t CONTAINERS COMPOSItQ MATRIX ,� REMARKS <br /> Id <br /> x <br /> I ¢ <br /> rte. <br /> w <br /> Q <br /> Rehnqui Iced By(Sigr+ature) <br /> me ecesved W (Stpnalurs) <br /> DeleRme <br /> lac�tJ gr�AROUND TUNE <br /> R��nqu�atned ° <br /> BY (5ignaturc) 0 18rrMe Remoed By (Signature) <br /> DaWT,me 24 HOUR❑ <br /> r <br /> RehNuished By(Sigift") DalelT4me 48 HOUR C1t Aecslve 10y (Stgnalure) Dalemme <br /> 1 i.4 5 A, 5 DAY- <br /> Dfsrq,SunoN Orf traf-Aocam <br /> paA�ea Shpmenl Canary Copy Shatuvw Prnlr Copy Sampler NOTE.Samples are discarded 30 days after resu}ts are rsporvad uNess athet atrangierments are made <br />