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Client'En-c <,\ 5" bcE SraT1c�1 <br /> ""CX _ GTr1C K?O� <br /> California SAMPLE CHAIN OF CUSTODY RECORD Address?^ �' '--cal <br /> — <br /> ti�4yodesto, <br /> (please print) Phone No.Water Labs Proj. MgrJContact M_ Pink- Field CopyP.O. Boz 4249 Ship samples to: White and Yellow-To Lahoratory with Samples <br /> CA 95352 1430 Carpenter Lane Record �_of 11 Yellow -Return to Client <br /> (E09) 527.4050 Modesto, CA 95351 + <br /> ANALYSIS REQUESTED <br /> PROJECTISITE NAME: --- <br /> A � <br /> PROJECTICONTRACTIPO NO.: <br /> ,.cy - GT <br /> '✓ <br /> NAM E,OFi� REMARKSISPECIAL INSTRUCTIONS <br /> SAM;LE <br /> !.LAB USEONLAMPLE i m NUMBER <br /> F OF <br /> Q 4 <br /> LAB I.D. I.D. DATE TIME U s C7 TCON•AINERS IV <br /> �7 <br /> S/�OCO rfl 7 .� ✓ .C. ✓ . <br /> L - <br /> o coo .A L - Zp 7 ✓ ✓ <br /> 5 <br /> F, <br /> RELINQUISHED BY SIGN DATE(TIME <br /> RECEIVED BY SIGN DATERIME RECEIVED FOR LABORATORY <br /> I BY (SIGN) ( � 'i� t DATElTIME <br /> b <br /> RECEIVED: <br /> COLD AND INTACT OTHER PRESERVATIVE ZYES �No <br /> -_OTHER: <br /> - Y 7-/ -'/0 TURN AROUND TIME: <br /> 00 <br /> :10-Day <br /> SHIPPED VIA: -FED X - UPS -.OTHER: <br /> SHIPPING ORDER NO.: 7-24-Hr 2-Day <br /> �'3. -Day <br />