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Clienttr� <br /> Calffornia SAMPLE CHAIN OF CUSTODY RECORD Address tjTD1 Cts, <br /> Water Labs (please Print) . Phone hio. <br /> OP.O. <br /> Proj. Mgr./Contact KAA <br /> Box 4249 Ship samples to: Pink-Field Copy <br /> Modesto,CA 95352 1430 Carpenter Lane �1366 . White and Yellow-To Laboratory with Samples <br />- (209)527-4050 Modesto,CA 95351 Record of Yellow-Return to Client <br /> PROJECTISITE NAME: -11S ANALYSIS REQUESTED ' <br /> PROJ ECTICONTRA <br /> CTlPO NO.: <br /> To- 603 <br /> ,ME OF SAMPLER: v REMARKSISPECIAL INSTRUCTIONS <br /> L <br /> LAB USE ONLY SAMPLEa ' m NUMBER <br /> W< OF <br /> LAB I.D. I.D. DATE TIME o ¢ CON- <br /> 0 ITAINERS <br /> t — Tre A s 'b 1 56D &AL, 0)�L <br /> N `TRNkZf lam 6-AL, 4G, �� a <br /> E <br /> N Zp { _. . <br /> lv A T 1� 1 . <br /> ENVIR <br /> FF1LINQUISHED BY SIGN DATEfTIME RECEIVED BY SIGN DATE/TIME RE EIVER F R LABORATORY <br /> BY(SIGN): DATEITIME /_ <br /> 1 R i IVSD: �iJ�S <br /> OLD AND INTACT OTHER PRESERVATIVE ❑YES ❑NO <br /> ❑OTHER: <br /> TURN AROUND TIME: <br />• SHIPPED VIA: ❑FED X ❑UPS OTHER: OP HIPPING ORDER NO.: <br /> 1124-Hr 02-Day ay ❑1t7 Day <br />