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OHAIN OF CUSTODY RECORD Bill To <br /> Sh erweed 8071 N Larder Avenue 1 <br /> J� P O Box 937 <br /> .L..]. Hilmar, Callfornfa 95324 <br /> absL (209) 667-5258 Attention P <br /> G O R r O R A T 1 O N FAX (209) 667-25E1 ��Sage of <br /> Job NumberPt] # Protect Name <br /> Samplers (Signature) Site Address <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLE �,} Q S <br /> C� <br /> (IDENTIFICATION) (AATH/DAY/YR) (HOUR/MIN) CONTAINERS COMPOWE) MATRIX(GRAB OR � � �Q��� REMARKS <br /> MW-4--Q0 <br /> } r <br /> II � , <br /> I <br /> j <br /> I� <br /> I <br /> II <br /> I <br /> Relinquished By (Signature) Datetrime Received By (Signature) DateTme TURNAROUND TIME <br /> '-�I I S h� C:>/'-) 4 Vr,, <br /> Relinquish d By (Signature) Datemme Received By (Signature) Date/Time 24 HOUR ❑ <br /> 48 HOUR ❑ <br /> Relinquished By (Signature) Dateme Received By (Signature) Date�me <br /> m <br /> 5 DAY <br /> DISTRIBUTION Original-Accompanies Shipment Canary Copy Sherwood Pink Copy Sampler NOTE Samples are discarded 30 days after results are reported unless other arrangements are made <br />