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Client A-� S :�KRl L'AT11)A <br /> CaliforniaSAMPLE CHAIN OF CUSTODY RECORD Address Pt° I66XVS �t�a N ► AI �� b T— e <br /> Water Labs (please print) Phone No. <br /> Proj. Mgr.IContact PAOG-• t <br /> � 100 �= <br /> 1 <br /> � P.O. Box 4249 Ship samples to: Pink-Field Copy <br /> Modesto, CA 95352 1430 Carpenter Lane l White and Yellow-To Labgr& with SaEftplM <br /> (209) 527-4050 Modesto, CA 95351 Record of Yellow - Return to Client 4 <br /> r . c. <br /> a. <br /> PROJECT/SITE NAME: �(Z1 7�T 1J ANALYSIS REQUESTED ttZ ;_ <br /> O—/VL } !— w <br /> PROJECT/CONTRACT/130 NO.: o: <br /> CD Er <br /> Cc <br /> NAME OF SAMPLE `v REMARKS/SPECIAL INSTIONS <br /> 1 <br /> 11 AB USE ONLY SAMPLE KIZ m NUMBER <br /> Q OFLAB I.D. I.D. ATE QCONO TAINERS-527 X o�'o <br /> 16 <br /> `'moo oT+1 a 1�'4lNOW w <br /> 0 � <br /> J <br /> Q <br /> O <br /> W <br /> H <br /> RELINQUISHED BY (SIGN) DATE/TIME RECEIVED BY (SIGN) DATE/TIME RECEIVE FOR LABORATORY <br /> BY(SIGN): ` I" L'—' DATEITIME ' <br /> 9U <br /> Y RECEIVED: <br /> t . OLD AND INTACT OTHER PRESERVATIVE ❑YES"KNO <br /> ❑OTHER: <br /> 1 <br /> TURN AROUND TIME: <br /> SHIPPED VIA: F D X ❑UPS ❑OTHER: SHIPPING ORDER NO.: <br /> F-24-Hr [12-Day Day E10-Day <br /> c� <br /> c � <br /> T_ <br />