Laserfiche WebLink
i <br /> I <br /> u � c <br /> Client 5,lll d t <br /> SAMPLE-CHAIN OF CUSTODY RECORD Address <br /> f. l�z rrrL '�r� %S3a <br /> ����®1'i14A (please Print) Phone No. <br /> za4 �zy- �lGf3 �� <br /> t <br /> \ WCde`Lczbs Proj.mg0contact <br /> 0034 � <br /> P.O.Box 4249 Ship samples to: Pink•Field Copt <br /> � ,II White and Yellow•To Lahoralary with Samples <br /> Modesto,CA 95352 7436 Carpenter Lane Record ' of Yellow-Return to Cilen! <br /> (209)527.4050 Modesto,CA 95351 <br /> PROJECTfSITE NAME: ANALYSIS REQUESTED <br /> PROIfE)CTiCONTRACTIPO NO.:, <br /> LL/11nn�/L °ate V�1 �� id <br /> REMAR!(SlSPECIAL INSTRUCTIONS ' <br /> NAME OF SA PLER: ^ <br /> AIL <br /> LAB USE ONLY SAMPLE a NUOMFER L f� <br /> LAB LD. I.D. DATE TIME U <br /> cr CDN• <br /> V � TAlNERS <br /> In <br /> 15 -- <br /> �G <br /> DATElTIME R CEIVED F R LABORATORY <br /> RELINOUIS 0 BY SIGN DATEITIME RECEIVED 13Y SIGN h p r t <br /> 77� �� DATEiTkME! <br /> C RECEIVED: <br /> 9COLD AND INTACT OTHER PRESERVATIVE i:YES XNG <br /> i_.OTHER: <br /> TURN AROUND TIME <br /> — J <br /> :724-Hr C2-Day L:5 Day tO Day <br /> SHIPPING ORDER NO.: <br /> SHJPPED VIA: CFED X I,CIUPS DOTHER:— <br /> �� IJ <br /> I <br />