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Zalifornia Water Labs <br /> C7) <��n P. 0. BOX 4249 SiLVio?_ WpRKf�uy Client <br /> m =wcj1430 CARPENTER LANE p Address `�� f/i r;" t° <br /> -5; MODESTO,CA 95352 N f�Cex, �Q u-ip,eKt�1� l�rfY I //<- <br /> Q PHONE(209)527-4050 Phone No. `- f �'2 '�`1�•S 7 J .3S <br /> Contact Person <br /> ` CHAIN OF CUSTODY RECORD ple <br /> co CHAIN <br /> W Oc <br /> PROJECT Nik- <br /> _ u <br /> SAMPLERS (signature) a <br /> / Number Ne <br /> of REMARKS <br /> Station �- <br /> Number Date Time o b Station Location Lon- n' <br /> 1. tainers ( .• <br /> ccu <br /> _ - I <br /> Rel <br /> �iby(Si r�yture):e): Date / tme Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> Comp ny or/Age cy: 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 /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Company or Agency: (signature) <br />