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California Water Labs c'000w;ce- i�ious- TRY <br /> P.O.BOX 4249 Client '� <br /> 1430 CARPENTER LANE Address !a9 lam, Go2flNr S7K ,� <br /> MODESTO,CA 95352 <br /> PH0NE(209)527-4050 Phone No.(POV St<oCa 3I! <br /> Contact Person D1RNC— <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: OPV <br /> GOODt✓AC 1A/D(Jsr/P y - D <br /> SAMPLERS (sign tur o L <br /> Number Q a <br /> of C`Q REMARKS <br /> Station <br /> Number Date Time o A Station Location Con- V <br /> tainers ,,r^ / q <br /> ! !� ! 1JU-J�IJ� I <br /> v � P(t f•) Sbuty ENp <br /> 429 � . 2) wo <br /> SHfiPtt= �, 74 EN <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 Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Reli i ed by( i atLre): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Com ny or Agency: 7/'� (signature) cw, ' <br /> • W L SQ,i � � �� C`X <br />