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California Water Labs , <br /> P.O. BOX 4249 Client c2 <br /> 1430 CARPENTER LANEAdd <br /> ress <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 Phone No. <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD �• (please prin+) <br /> PROJECT NAME: l = <br /> F•- <br /> IE Loe Q r7 C_ <br /> '.�y'dD s g Li. W <br /> = U <br /> SAMPLERS <br /> Number Q z <br /> Ye �f <br /> of REKARV9— oLAJ <br /> [C <br /> -`!� o Q a ® 7 J) <br /> Station N - O.A.oB Uj <br /> Number Date Time A Station Location Con- <br /> tainers <br /> U! Q S <br /> u c� Z <br /> W <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 /> _ �,,vtgrlhed signature): Date / Time Received for Laboratory by: Date / Time Re�arks/Shipping ,Information <br /> '� y cy, 17-2,0—Py (s ignature) <br /> ( C <br />