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�%AAIN OF CUSTODY RECO <br /> SAMPLERS:(Signature) <br /> SHIPPING INFORMATION <br /> Phone: <br /> SHW TO: <br /> t Shipper <br /> t Address <br /> .- <br /> Date Shipped_-- <br /> Shipment Service <br /> Airbill No. <br /> ATTENTION: Cooler No. <br /> Phone No. <br /> e nqu stied by:4signature) Recelv7d by: (signature) ate Ime <br /> Relinquished by: (Signature) Received by: (Signature) Daterrime <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: fSignature) Receive for laboratory by:(Signature} Pate/Time <br /> Analysis laboratory should complete "sample condition upon receipt" section below, sign and return 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 /> Whits-Sampler Canary•Return Copy To Shipper Pink-Lab Copy <br />