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C C C I l 4 `" •` ° r 1 r" T ( T' r r, f" � P, C C C C t <br /> r <br /> F Environmental Consultants, Inc. <br /> FIGURE 4 Typical Chm of CWtody Sheet Post Office Box 6729 <br /> CHAIN OF CUSTODY RECORD Modesto, CA 95355-6729 <br /> (209) 579-8138 <br /> FPRIIICI:"AME. <br /> �~ D <br /> SMVLfRS (signature) Number <br /> � REM ARK 5 <br /> of <br /> Station <br /> Number Date Time Station Location tainers <br /> l <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 Agency: (signature) <br />