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California Water Labs <br /> Manu h <br /> P.O.80X 4249 Client <br /> x) 1430 CARPENTER LANE <br /> c� MODESTO,CA 95352 Address— <br /> s, <u PHONE(209)527-4050 Phone No. u! '2 �✓� a_7 5 � <br /> Contact Person <br /> �-� CHAIN OF CUSTODY RECORD (please print) <br /> C- PROJEC,7'RAME: <br /> �VzrA 1P S Weir+✓ C �D <br /> SAMPLERS (signature) <br /> Number <br /> ` of REMARKS <br /> Station <br /> Number Date Time � � Station 'Location Coh- <br /> tainers `'W , <br /> 12--Z <br /> a 4eu <br /> r wo w <br /> Relin isnature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received b <br /> y (signature): <br /> Compa or enFy: Z ` Company or Agency: Company or Agency:Y: 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 /> •/, K-AGE_„ � ��� /G2� <br />