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. r <br /> California Water Labs <br /> P.0.BOX 4249 Client STbCf(tdN 6E ► �6 r' 9S2d! t <br /> 1430 CARPENTER LANE Address EV, 130 S <br /> MODESTO,CA 95352 Phone No. �� — 3�3 <br /> PHONE(209)527.4050 r <br /> Contact Person 41 � �= <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: 570r/yMAJ SE71jvjct YTAT(C N`` 91 <br /> � / <br /> 0 <br /> iee- DOI-. <br /> . Z eb LJ� <br /> SAMPLERS (signature) <br /> Number V v, <br /> A�fA�Vt4i !!'' <br /> of �0o ti REMARKS <br /> Station `'- <br /> Number Date Time E Station Location Con- <br /> tainers <br /> fr_ 11119nki> r Yr- <br /> Relinquished <br /> rRelinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Cate / 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 /> Rel'n fished (signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping information <br /> Co any or Agency: y 0 <br /> (signature) <br /> �� ��9'2 E <br />