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California Water Labs, Inca <br /> P.O.BOX 4249 <br /> i 1430 CARPENTER LANE—SUITE G <br /> MODESTO,CA 95352 \C; <br /> PHONE(209)527-4050 F <br /> '1 CHAIN OF CUSTODY RECORD \�L7 <br /> PROJECT NAME: <br /> - SAMPLERS i g �t�na u e � c Q 1 '`'� `� <br /> s Number Q fie. \`V x \t\ \ REMARKS <br /> { \ 1 <br /> of <br /> Station n a <br /> Number Date Time L Station Location tainers \ � <br /> r <br /> C <br /> � a -rc-13-67- 110- 1 q � X Ix a- ? <br /> 1,. <br /> k_ <br /> d <br /> Rel 14nqu `36 bye' natufe ate / ime- Received (signature): Relinquished by(signature): Date / Time Received by (signature): <br /> y� ceivd b ( it <br /> Com�any b A Company or Agency: Company or Agency: Company or Agency: <br /> T v <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 /> Relinquished by(signature): Date / Time Received for Laboratory b Date Time Remarks/Shipping in Information <br /> r� Y Y� l PP 9 <br /> Company or Agency: (signature) <br /> _ 1 � <br />