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F <br /> California Water LabsAMC �Citju (-, <br /> P.O. BOX 4249 Client <br /> C W <br /> U 1430 CARPENTER LANE Address �` <br /> MODESTO,CA 95352 Phone NO. <br /> 4 WPHONE(209)527-4050 <br /> -, � Contact Person <br /> A CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME, <br /> IAMPp t$rurl�y��L�" " ' Number Q°moi <br /> r,f\-�J�/l/"// � REMARKS <br /> etc-, of � <br /> . Station <br /> Number Date Time o ' Station Location tainers <br /> u � <br /> IT <br /> 36 ( 3 X X X 37 <br /> WA 6r- 30- - #~z x X x x 3g <br /> R {�b��n Da;e / Ti/me Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> fp <br /> Coma or rtdfprry//�f/�+ �1 ompany or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date <br /> /TTIIW/ 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 /> /O <br /> Company or Agency: (sign ture) <br /> /� <br />