Laserfiche WebLink
Client T 1 Ki Lky-a Al K<<�'WT` <br /> California SAMPLE CHAIN OF CUSTODY RECORD Addres��.. j. a11? U3' fl - aA <br /> \ (please print) Phone t�:�241'���5 S1'cctC(p <br /> Water Labs <br /> / O Proj. Mgr.IContactP•�u- <br /> P.O. Box 4249 Ship samples to: Pink•Field Copy <br /> Modesto, CA 95352 1430 Carpenter Lane 1 ` White and Yellow•To Laboratory with Samples <br /> (209)527.4050 Modesto, CA 95351 Record of Yellow• Return to Client <br /> 1 <br /> PROJECT/SITE NAME: ANALYSIS REQUESTED ' <br /> PROJECTICONTRACTIPO NO,: <br /> NAME OF SAMPLER: G` �� REMARKS/SPECIAL INSTRUCTIONS <br /> �` 641 <br /> LAB USE ONLY SAMPLE a m NUMBER V <br /> Q OF <br /> LAB I.D. I.D. DATE TIME O CON- / I <br /> U O TAINERS <br /> ✓ ✓ i� i <br /> �J <br /> 61 <br /> t <br /> RELINQUISHED BY SIGN DATEITIME RECEIVED BY SIGN DATE(TIME EC VED FOR LABORATORY <br /> BY(SIGN): /+i✓r3 DATEITIME_/f v <br /> RECEIVED; Y <br /> COLD AND INTACT OTHER PRESERVATIVE DYES f/1�10 <br /> (]OTHER: (J_ <br /> �W L � t` 00n TURN AROUND TIME: <br /> SHIPPED VI • ❑FED X ❑UPS ❑OTHER: SHIPPING ORDER NO.: 024•Hr 02•Day 05•Day ?*-Day <br />