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io41Zi o _ r3og <br /> AMAIN OF CUSTODY RECORD ill To: = <br /> 8071 N. Lander Avenue <br /> Sherwood P.O. Box 937 t� <br /> Hilmar, California 95324 <br /> Labs (209) 667-5258 Attention: Phone: <br /> C O R P O R A T I O N FAX (209) 667-2581 Page of <br /> Job Number P.O.# Project Name <br /> / 2 <br /> Samplers:(Signature) Site Address <br /> Z ��N Co <br /> NUMBER TYPE <br /> SAMPLE LOCATION DATE TIME SAMPLE <br /> (IDENTIFICATION) (MTHlDAY/YR) (HOUR/MIN) OF (GRAB OR <br /> CONTAINERS COMPOSITE) MATRIX �'���Q�,�� Q REMARKS <br /> �a <br /> �o) 7e <br /> ZF3e' :' heddByr.: ignatur Datefrime Received By:(Signature) Datefrime <br /> TURNAROUND TIME <br /> Re in uished By:(Si ature) Datefrime 14eceive By:(Signature) D tefTime 24 HOUR ❑ <br /> '� /z a� /� �D ! fi.E . C L • � N-/ -�1 1 �� 48 HOUR ❑ <br /> linquished By:(Signature) Date/Time Received By:( ignature) Date/Time �5 DAY.❑` <br /> DISTRIBUTION: Original-Accompanies Shipment Canary Copy:Sherwood Pink Copy:Sampler NOTE:Samples are discarded 30 days after results are reported unless other arrangements are made. <br />