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=i <br /> CHAIN OF CUSTODY RECORD Bal To SHERWOOD LABS <br /> PO BOX 937 <br /> 8071 N Lander Avenue <br /> J� <br /> SherwoodP D Box 937 HILMAR, CA 9a3Z4 <br /> L� Hilmar, California 95324Labs _ <br /> 1209) 667-5258 Anent:vn phone <br /> C o P P Q P A 7 1 O N FAX (209) 667-2561 VICKI RUBIS 209-667-5258 Page of <br /> ,lam N=berx Plated Name <br /> T <br /> 81 aRll i� ? :0s <br /> �1. M . u min fSO <br /> z <br /> Sampieis tSignature) Site Addresa �` <br /> SAMPLE LOCATION DATE; TIME NUMBER TYPE SAMPLE <br /> (tDENTIFiCAT 0N) (MTHMAYIYR) (HOUFtMdIN) OF (GRAS 00 MATRIX <br /> COKFAMERS COMPOSITE) REMARKS <br /> rn Uj- /401 0910 r z 6�-3foe~ va/ <br /> - <br /> 1.3 aS <br /> �''ai Ltd- 930 11b <br /> i,t}- <2S 3 - aa7 <br /> / s <br /> ReUn 1 fished By (Sigr>at ) DatefFmeReceived By (5ignaalre) Dzl � 77AA1'1-Vr <br /> - TUBI�IARDUI�D TiMF <br /> 9 .cam! <br /> Rabnqurshad By (Signaue) llatelTerne Received By (Signalure) [taste ime 24 HOUR Q <br /> 48 HOUR ❑ <br /> Ftelrrrquished8y (8gnature) EIat69Tnn)e Reserved By ISignalum) DmeMme P—Y <br /> DISTRIBUTION Orval-Accompanres Shipment Canam Copy SNruood Pink Copj Sampler NOTE Sampies are discarded 30 days atter Tesutl5 are unless oche nts ate made <br /> i <br />