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California Water Labs Oe T/zC2 _ C, /I <br /> P.O.BOX 4249 Client <br /> 1430 CARPENTER LANE Address R <br /> MODESTO,CA 95352 <br /> r. PHONE(209)527.4050 Phone No. <br /> Contact Person / -' ? �- <br /> C14AIN OF CUSTODY RECORD (please print) <br /> PROJECT- NAME: <br /> SAMPLERS (signature) P <br /> Number '4va <br /> / <br /> of RDtARKS <br /> � \ <br /> Station Con- <br /> Number Date Time Station Location tainers !� f'j <br /> 9 c� <br /> 3' �S <br /> t-y1 1.44"tT ,- '' <br /> IL 7 ii�'1 � L � S'F•".%ll� <br /> ;�- 2 <br /> Iv <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Tim Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Company_pr A _ � ,! (signature) <br /> g/�nc� ,_ �, <br />