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California Water Labs, Inc. 570 sate s , <br /> 1430 CARPENTER LANE-SUITEG7 a 3 3 <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 <br /> CHAIN OF CUSTODY RECORD <br /> PROJECT NAME: <br /> SAMPLE tgnaturA) Number e� i b b� v <br /> 8� REMARKS <br /> of �. T, <br /> Station n5 <br /> Number Date Time o i Station Location Con- p �� <br /> tainers <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Receive4,6y (signature): <br /> - Company or Agency: Company or Agency: Company or Agency: Company or Agency. <br /> Re_1 shed by(signature): D�te / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> (signature) <br /> Company or Agency: <br /> </ <br /> r' <br />