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CHAIN OF CUSTODY RECORD Bill TO �-�-� , - , , , ,,_,_ `, , x <br /> Sherwood RO. Lander Avenue <br /> P.O. Box 937 <br /> Hilmar, California 95324 <br /> Labs (209) 667-5258 Attention: Phone: <br /> C O R P O R A T 1 0 N FAX (209) 667-2581 Page of <br /> til <br /> Job Number P.O.# Project Name n4 <br /> Samplers:(Signature) Site Address v�� X01 <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE <br /> (IDENTIFICATION) (MTH/DAYNR) (HOUR/MIN) OF (GRAB OR MATRIX <br /> CONTAINERS COMPOSITE) 4V REMARKS <br /> Is <br /> U Cf <br /> Reli s e y:(Snature) Date ome Received By:(Signature) Date rime <br /> TURNAROUND TIME <br /> co <br /> Relinquished By. nature) <br /> DaIeFTime RBceiv d By:(Signature) DateTme 24 HOUR ❑ <br /> 48 HOUR <br /> Re6ng6shed By:(signature)\,,.. Date/Time Received By:(Signature) Date/ Time 5 DAY ❑ <br /> `STRIBUTION: Original-Accompanies Shipment Canary Copy:Sherwood Pink Copy:Sampler NOTE:Samples are discarded 30 days after results are reported unless other arrangements are made. <br />