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CHAIN OF CUSTODY RECORD*45VV5(Z SSS/4 J <br /> AMPLERS: mr;Lure) <br /> SHIPPING INFORMATION <br /> M: <br /> StInP TO: i <br /> Shipper <br /> Address --^—' 7 <br /> ` Date Shipped <br /> Shipment Service <br /> Airbill No. <br /> %TTENTION: Cooler No. <br /> 'hone No. <br /> Relinquished by: (SignatunvReceived by: (Signature) DatwTime <br /> i <br /> Helinquished by: (Signature) Received by: (Signature) Date/Time <br /> telinquished by: (Signature) Received by: (Signature) Date/Time <br /> lelinqulshed by: (Signature) Receive ratory by: (Signature) Date(Time <br /> Analysis laboratory should complete "Sample condition upon receipt" section below, sign and return top copy Jo <br /> Canonie Environmental Services, 113 W. March Lane, Stockton, Ca. 95207 <br /> Sample Site Date Analysis Sample Condition <br /> _ 'umber Identification Sampled Requested Upon cel t <br /> Mnllte-Sampler canary - Return Copy To Shipper Pink <br /> Lab Copy <br />