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_ C liforn is Water Labs, Inc. <br /> P.O.BOX 4249 <br /> 1430 CARPENTER LANE—SUITE G _ <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 <br /> CHAIN OF CUSTODY RECORD <br /> + PROJECT NAME: <br /> D <br /> \ Number Q�� t <br /> REMARKS <br /> of <br /> Station <br /> - bDate Time c L S ation ;Location <br /> Number Con j # <br /> T � tainers <br /> v co <br /> itZA <br /> t 10— �. <br /> i <br /> `_- <br /> R i uished y(signature): Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> any A�en 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:m <br /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Company or Agency: (signature) / <br /> vC� Il � <br /> C r <br /> �- V <br />