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Coal iforn is Water Labs <br /> J P.O. BOX 4249 Client S L'M Cts j1FRA 1`J Z 1A I.Priv <br /> 1430 CARPENTER LANE H.,q T(, <br /> MODESTO,CA 95352 Address <br /> •— -�5: PHONE(209)527-4050 Phony O. 3 <br /> Contact Person 5ra7T <br /> 4 CHAIN OF CUSTODY RECORD <br /> ` (please print) <br /> PWJECT R iE: <br /> SLTz// <br /> a <br /> SAMPLERS (signature) • s�y'�� <br /> �' Humber <br /> Station of Q t '\ W� M��u L,L� �'� �b�" - REMARKS <br /> a <br /> Number Date Time E Station Location Can' <br /> w c`s <br /> �} tainers <br /> ` 5,q111,016�(I) E-. 'FV 9• X I1 <br /> TAN <br /> t V 170-0 9. Hw I o <br /> IM k l IV <br /> tHNk <br /> T14tik /s� y <br /> (4 f 0L L <br /> Relinquished by(si a Date / T` :eceived by� (signa Relinquished by(signa : Date / T e Received b <br /> y (signatur <br /> CD r Agency: ompan Agency: Cam an ' <br /> R y gency: Co <br /> Agency: <br /> �1 <br /> Relinquished by ature): Date / T` Received b <br /> y (si_gna Relinquished by: Oate / T` Received by {si a}: <br /> Com or Agency: Compan gency Compan Agency: <br /> g y� Compan r Agency: <br /> Rel n uished�by(signature): Date / Time Receive for Laboratory by: Date / T` Remarks/Shipping In#ormation <br /> Co pang or Agency: (s` u e) <br /> C WL <br /> � Z <br />