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California Water Labs ' <br /> P O BOX 4249 Clint 5�Ta ck' OAI SE of t E 5 el l o N <br /> quo CARPENTEN Address p o 130X 5-0S/ S1 K. cA.q )Dl <br /> i�roDESTOoESTo,cn 35� 464-�r3�3 <br /> PHONE{ZOO 527-4= phone l�e -2�f <br /> u Contact Pwwn ! C <br /> CHAR OF CUSTODY RECORD ")o` twvj (pMMe Prwo <br /> PRWECT mw: S70c,000 slhirtci Smrto . <br /> SAliLERS (signature) �r ���a <br /> of � 'T`�� RFJIARiCS <br /> Station <br /> Number Data Time r Statim Location tairers <br /> vied . sttr% <br /> +�N a v .•res c s_o o rsrr - 3746 <br /> a y v r�roo N msMANAS nrK*t� ?n� <br /> i <br /> (6-60 N c. rK <br /> C406 Cb /'f Pr �- <br /> AspAIgty i&kl> cetom *oDa ro, /f FT .2-3 <br /> R in 1 <br /> y(=igaatwo): Date / Tier Received by (Signature): Relinquished by(signature): Data / Time Received by (signature); <br /> any or Nir <br /> 7d Sa L+�(� �7: �M. Campany or Agency: Compaay or Agency: Camp any or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (tigaature): <br /> Company or agency: <br /> Company or icy: Company or Agency: Company or Agency. <br /> Relinquished by(signature). Date / Time Received for Laboratory by, Date / Tine Ra■arts/Shipping Information <br /> Company or Agency: (signature) 74 <br />