Laserfiche WebLink
Client ,ate �.lAc' <br /> SAMPLE CHAIN OF CUSTODY RECORD Address ? 51 <br /> Cci <br /> Water Labs iforna Phone No. r <br /> (please print) <br /> Proj. Mgr.lContaci �+ ka <br /> t <br /> P.O. Box 4249 Ship samples to: Pink Field Copy <br /> White and Yellow•To Laboratory with Samples <br /> Modesto, CA 95352 1430 Carpenter Lane Yellow- Return to Client <br /> (209) 527-4050 Modesto, CA 95351 Record of <br /> PROJECTISITE NAME: ANALYSIS REQUESTED <br /> PROJECTICONTRACT/PO NO.: �c <br /> 4 � <br /> ME OF SAMPLER: �Q �(�� REMARKS/SPECIAL INSTRUCTIONS <br /> LAB USE ONLY SAMPLE ti ao NUMBER 1 <br /> LAB I.D. I,D. DATE TIME U TAI NIERS " p� <br /> LN /i�L 7i <br /> y <br /> r 7/ 41 � <br /> RELINQUISHED BY (SIGN) DATE/TIME RECEIVED BY (SIGN) DATErTIME RECEIVED FOR LABORATORY <br /> BY(SIGN): DATEITIME <br /> RECEIVED: <br /> LCOLD AND INTACT OTHER PRESERVATIVE LYES -NO <br /> D 0TH ER: <br /> TURN AROUND TIME: <br /> C7 <br /> '-10-Day <br /> StHIPPED VIA: EIFED X -.UPS COTHER: SHIPPING ORDER NO,: <br /> C;24-Hr L-12-Day E5-Day <br />