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California Water_ Labs Y?'000 J .SeRV14 S,y�ati <br /> Client 9S��l <br /> P.O.BOX 4249 AddresspO,�A� <br /> 1MCARPENTER LANE � 3 <br /> MODESTO,CA 95352 Phone No. �[� F • � <br /> PHONE(209)5274050 ContaCt Person � b <br /> CHAIN OF CUSTODY. RECORD (p+eaae print) <br /> PROJECT fiAlSE: . TTAT/ • <br /> 1 ti <br /> SAMPLERS (signature) [CJI Humber �c4� R.LK RK5 <br /> of <br /> Station Con- <br /> Number Date Time Station location tainers ` <br /> u 0 <br /> M <br /> 5"RMp1-6 MID L1 <br /> k <br /> Daae / Time Received by (signature): <br /> Relinquished by(signature): Date / Time Received by (Si'gnature); -Relinquished- <br /> Company <br /> y s :gna ure ' <br /> Company or Agency; Company or Agency: . <br /> Company or Agency: Company or Agency: <br /> Date 0 ime Received by (signature): <br /> Relinquished by(signature); Date 1 'Time Received by (signature): Relinquished by: <br /> . <br /> Y or <br /> an <br /> Com <br /> Agency: U- Company or Agency;, <br /> mpCoany or Agency:' P <br /> Company or Agency: 9 <br /> Re in fished ` signature): Date / Tim`e Received for laboratory by: Date / Time Remarks/Shipping Information <br /> 3l ( gnat rye) °2.JS <br /> ,( . ,y P� <br /> any-.or Agency: �y P� - - <br />