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,%Iifornia Water Labs, inc. r <br /> P.O.BOX 4249 <br /> 1430 CARPENTER LAN E—SUITE G <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 <br /> CHAIN OF CUSTODY RECORD `\A\ <br /> t <br /> PROJECT NAME <br /> � � D 1, (J <br /> 1 111 Q �y <br /> SAMPLERS (gnat/ /e) Number <br /> REMARKS <br /> of <br /> Station., - o -� Con <br /> Number J. Date Time V Station,,Location i ! <br /> v c� tainers - <br /> =_ - -r�)3707- olio 1 XXX j r /fi r <br /> t .L VDI - <br /> Rel nq 3s:f d by` igna ure Date Tiare Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> Co a r enc /�� 7\ ompany 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 /> f Relinquished by(signature): Date' / Time Received for Laboratory by: Date / Time Remarks/Shipping Information. <br /> Company or"Agency: (s " itu`re) <br /> � L/ t <br />