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.. ` ... tom' ��.A'+r,r.r.r• - .. t .. ,` <br /> Client <br /> � SAMPLE CHAIN OF CUSTODY RECORD Address <br /> tW (please print) PhOnB N0. <br /> 0450 Proj. MgrJContect <br /> P.O. Box 4249 Ship samples to: Pink-Field Copy <br /> Modesto,CA 95352 1430 Carpenter Lane White and Yellow-To Laboratory with Samples <br /> (209)527.4050 Modesto, CA 95351 Record of Yellow-Return to Client <br /> PROJECT/SITE NAME: ANALYSIS REQUESTED <br /> PROJECT/CONTRACTIPO NO.: <br /> A s �, <br /> NAME OF SA (SER: /� REMARKS/SPECIAL INSTRUCTIONS <br /> t [ ✓ <br /> LAB USE ONLY SAMPLE a a NUMBER Q^} p <br /> LAB I.D. I.D. DATE TIME Qv CON. 1✓✓ 1 <br /> TAINERS <br /> '41M X <br /> 3 Zm _A3 i t yC '4 <br /> ex q <br /> RE NQUISHED BY DATEITIME RECEIVED BY SIGN DATE/TIME R _CEIVt FOR LABORATORY <br /> tip, BY(SIGN) �Lyt-� ^ DATEITIME �? <br /> 90 <br /> RECEIVED: <br /> r COLD AND INTACT OTHER PRESERVATIVE ❑YES �60 <br /> ❑OTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA: ❑FED X ❑UPS ❑OTHER: SHIPPING ORDER NO.: 024-Hr 02-Day -Day 010-Day <br />