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CHAIN OF CUSTODY RECORD Bill To: <br /> 8071 N. <br /> Sherwood P.O. Box 937 Lander Avenue <br /> Hilmar, California 95324 <br /> Labs (209) 667-5258 Attention: Phone: <br /> C O R P O R A T I O N FAX (209) 667-2581 Page of <br /> Job umber P.O.# Project Name <br /> Samplers:(Signature) Site Address <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE } y ` <br /> (IDENTIFICATION) (MTH/DAY/YR) (HOUR/MIN) OF (GRAB OR A, <br /> 1 CONTAINERS COMPOSITE) MATRIX REMARKS <br /> T' 1 <br /> Re nquis By:(Signature) Date rime Received By:(Signature) Date rime <br /> TURNAROUND TIME <br /> Re inquished By: i atuie)i D01e/4na Received BJ:(Signature) Da /Time 24 HOUR ❑ <br /> 48 HOUR <br /> ,.. . � ; <br /> Relinquished By:(Signature) Date rime Received By:(Signature) Date/Time 5 DAY ❑ <br /> DtSWIBUTION: Original-Accompanies Shipment Canary Copy.Sherwood Pink Copy:Sampler NOTE:Samples are discarded 30 days atter results are reported unless other arrangements are made. <br />