Laserfiche WebLink
WJCalffornia SAMPLE CHAIN OF CUSTODY RECORD Address -, I / W Pi�l�l, !�l <br /> \ Water Labs (please print) Phone No. <br /> Proj. Mgr.lContact '' -!o07 ' <br /> !LI <br /> P.O. Bax 4249 Ship samples to: Pink•Field Copy <br /> JI <br /> Modesto,CA 95352 1430 Carpenter'Lane White and Yellow-To Labiii*'atorywth Sk��es <br /> (209)527.4050 Modesto,CA 95351, Record of Yellow-Return to Ciie '' <br /> rt <br /> •I ' <br /> [1 <br /> PROJECTISITE NAME: ANALYSIS REQUESTED <br /> PROJECTICONTRACTIPO NO.: L')f <br /> - Cl <br /> AI7 �J y�- �?� F <br /> NAME OF SA ER: �-�--_ REMARKSISPECIAL INSTRUCTIONS <br /> _ <br /> e ja USE ONLY SAMPL a m NUMBER <br /> LAB I•D. LD. DATE TIME OF <br /> v � TAINERS <br /> F-V <br /> RE UiF.%KD BY IGN DATE/TIME RECtIVED BY SIGN DATE/TIME RE EIV FOR LABORATORY <br /> 11.11f 3:4 BY(SIGN): -g DATEITIME l / .y` <br /> RECEIVED: <br /> COLD AND INTACT OTHER PRESERVATIVE OYES'�<NO <br /> ❑OTHER: <br /> TURN AROUND TIME: <br /> SNIPPED VIA: OFED X CUPS ❑OTHER: SHIPPING ORDER NO.: 024•Hr 02-Day 05-Day 1t}•Day <br />