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OHAIN OF CUSTODY RECORD 7o <br /> Bill To <br /> o r ;?c <br /> 8071 N Lander Avenue <br /> Sherwood <br /> P O Box 937 <br /> Hilmar, California 95324 <br /> Labs (209) 667-5258 AttentionT SPE/ Phone 'y�, Page f of <br /> C O R P O R A T I O N FAX (209) 667-2581 <br /> Job Number PON Project Name <br /> Samplers <br /> �S—ign_ � } Site Address <br /> �4 <br /> �p��OrLO <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE <br /> (IDENTIFICATION) {MTHIDAYIYR) (HOURIMIN) OF (GRAB MATRIX Q� �/ <br /> CONTAINERS COMPOSITE) Z �` � h REMARKS <br /> 71Gv I sv�J 2riF� f� rf <br /> r'°)1 f r 4/f - <br /> I <br /> Relinquished By (Signature) Date/Time Received <br /> By�(Signasure) 1, Date/Time TURNAROUND TIME <br /> �.mgwat <br /> shed By {signature) 6atEf/Tilne U R&eived By (Signature) 24 HOUR ❑ <br /> 48 HOUR ❑ <br /> R inqurshed By (Signature) Date/Time Received By (Signature) DatelTime 5 DAY D— <br /> DISTRIBUTfON Original Accompanies Shipment Canary Copy Sherwood Pink Copy Sampler NOTE Samples are discarded 30 days atter results are reported unless other arrangements are made <br />