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CAIN OF CUSTODY RECOW <br /> SAMPLERS: (Signature) <br /> SHIPPING INFORMATION <br /> Phone: <br /> SHIP TO: Shipper <br /> �! _i- /.•� c y Y Address r�- <br /> Date Shipped <br /> Shipment Service <br /> Alrbiil No. <br /> ATTENTION: -' 4.- Cooler No. <br /> Phone No. f •r ` y y <br /> Relinquished by: (Signature) Received by: (Signature) DatelTime <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Receive for laboratory by: (Signature; D"ate Ime <br /> Analysis laboratory should complete "sample condition upon receipt' section beflow, sign and retum top copy to <br /> Canonle Environmental Services, 83 W. March Lane, Stockton, Ca. 95207 <br /> Sample Site Date Analysis Sample Condition <br /> Number Identification Sampled Requested Upon Receipt <br /> T <br /> White•Sampler Canary-Return Copy To Shipper Pink-Lab Copy <br />