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California Wat r Labs /, <br /> P.O.BOX 4249 Client s i 4I • �] <br /> 1430 CARPENTER LANE Address 21, �� <br /> MODESTO,CA 95352 <br /> PHONE(209)527.4050 Phone No. � - <br /> Contact Person ' <br /> CHAIN OF CUSTODY RECORD J (please print) <br /> PROJECT NAME: �i 1 +t \� l i4 ' rl `iyJ <br /> 1 <br /> c AD-O2/®o/-,4 a�~��D �a�� E`'j ln�( �rA, <br /> .SA <br /> MPIERS (slgnat�ucrJe�ht' - Number �� �_ Y �, 0 1 <br /> MAR <br /> of �r X411 JY' lh REKS <br /> Station n Con- <br /> Number Date Time Station Location tainers `o�� �0 <br /> L5_6-t <br /> _ s"7,( wo. w it z �C X x J Z <br /> i <br /> 00 <br /> Relinquished by(signature): Date / t Received by (sig ature): Relinquished by(signature):'Lte / Time eceived by' (signaturjj-1 <br /> i <br /> Comjny or Agency: / Company-or Agency: Company-or-Agency: / Company-or-Agency: <br /> Relinquished b F ature): Date / T,ime Received by (Signatu�ej: Relinquished bar:/ Date Time Received by (signal <br /> Como- r Agency: Company_or Agency: Com�y-or Agency: / Compan or cy: <br /> Rel jt hed y(si ature e / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> n " rert� i;1os' (signator ) i 5 � �•b <br /> Com a y r A— y y�j,��/ `J� / <br />