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Client ' I <br /> • �� SAMPLE CHAIN OF CUSTODY RECORD Address <br /> :4PI:tt Calff�orn Phone No. r_ <br /> Water Labs <br /> (please print) <br /> Prod. Myr.lContact ' <br /> 1333 <br /> tmodesl:040 <br /> - Pink•Field Copy ' <br /> P.O. Box 4249 Ship samples to: White and Yellow•To Laboratory with Samples <br /> A 95352 1430 Carpenter Lane Recordo ofYellow•Retum to Client <br /> (209)527050 Modesto,CA 95351 e 0 <br /> PR0.IECTISITE NAME; ? <br /> NALYSIS REQUESTED <br /> '� <br /> �} 's <br /> P,ffJECTICONTRACTWO NO.: < <br /> REMARKSISPECIAL INSTRUCTIONS <br /> N 'E OF SAMPLER: <br /> LAS USE ONLY SAM E NUMBER ' <br /> DAB I.D. IA. DATE TIME <br /> 4]i es2 t Co r L <br /> 134'► Ella <br /> �Ji 15e�1 v <br /> r3 Cel,kcr ~ <br /> S , <br /> Go <br /> � G <br /> 7 � x r- `.. <br /> >� <br /> ± RECEIVED BY SIGN DAYERIME RECEIVED FOR LABORATORY <br /> RELINQUISHED BY SIGN DATEITIME ^DATEIfIM �b <br /> BY(SIt3N): <br /> RECEIVED: <br /> 4q6LD AND INTACT OTHER PRESERVATIVE DYES ENO <br /> OOTHER: <br /> y TURN AROUND TIME: <br /> SHIPPED VIA: OFED X CUPS ❑OTHER: <br /> SHIPPING ORDER NO.: 17x4•Hr C2-Day ;•�SDay C10Day <br />