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'J <br /> WAIN OF CUSTODY RECORD ill TO. <br /> N. <br /> Sherwood P.O.'Box 937 Lander Avenue <br /> Hilmar, California 95324 <br /> &SIlLabs (209) 667-5258 Attention: Phone: Page Of <br /> D R P O R A T 1 O N FAX (209) 667-2581 <br /> Job Number P.O.# Pro',/jtme <br />� l�C�✓ �� � �1 0�1 k <br /> Samplers:(Signature) Site Address <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE <br /> (IDENTIF',:,ATION) (MTH/DAYNR) (HOUR/MIN) OF (GRAB OR ,`4/ ,`� <br /> CONTAINERS COMPOSITE) MATRIX �• �Q ,�� REMARKS <br /> ,0 D >e,' <br /> �� <br /> CornAoc fe I— ✓ ✓ P,�. ConJ2r5cL-�-i c w� <br /> Relin By:(Si Lure) Datef ime Recei d By:(Signature) Date/Time TURNAROUND TIME <br /> p� <br /> Relinquished By:(Signal re) Datemme 7,ae <br /> edBy:(Signaturre)) Da emms 24 HOUR ❑ <br /> 114C/1 &V�l o G 3 48 HOUR ❑ <br /> R40inquished By:(Signature) jV Datef Time Received By:(Signature) D te/Time rj DAY <br /> DISTRIBUTION: Onainal-Accompanies Shipment Canary Copy:Sherwood Pink Copy:Sampler NOTE:Samples are discarded 313 days after results are reported unless other arrangements are made. <br />