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Client <br /> �� <br /> SAMPLE CHAIN OF CUSTODY RECORD Address _6 ) , <br /> calwomia {please print) - ' Phone No. <br /> Water Labs 1294 Proj. ft-frontact <br /> , I <br /> Pink- f=ield Copy <br /> P.O. Box 4249 Ship samples to: White and Yellow-To Laboratory with Samples <br /> Modesto, CA 95352 1430 Carpenter Lane Record of Yellow-Return to Client <br /> (209)5274050 Modesto, CA 95351 <br /> ANALYSIS REQUESTED - — <br /> PROJECTISITE NAME _ <br /> — <br /> PROJECTICONTRACTIP NO.: <br /> REMARKSISPECIAL INSTRUCTIONS <br /> NUMBER <br /> OF <br /> LAB USE ONLY SAMPL <br /> LAB l E£ IA. DATE TIiv4E Ua � TARN RS r\ <br /> Ll <br /> aj <br /> RECEIVED BY SIGN DATEMME /`RECE1VlED FOR LABORATORY <br /> R {NQUISHE BY SIG DATEMME RECEIL�BY DATEMME <br /> Ir (SIGN). 4C <br /> RECEIVED: <br /> OLD AND INTACT OTHER PRESERVATIVE ;:YES NO <br /> C OTH ER: <br /> TURN AROUND TIME: <br /> E:24-Hr !:2-Day 4-Day 7—10-Day <br /> • SHIPPED VIA: FED X =UPS -OTHER: <br /> SHIPPING ORDER NO.: <br />