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CHAIN OF CUSTODY RECORD Bill TO <br /> LO <br /> FO BOX 937 <br /> LO 8071 N Lander Avenue <br /> Sherwood PO Box 937 <br /> n" Hilmar, California 95324 <br /> Labs (209) 567-5258 <br /> C O R A O R A T / O N FAX (209) 557-2581 Attention Phone 11 YIC39 HUBT-cz 209) F97-5258 Page j—of-L— <br /> Job <br /> --Job Number PO Y Prr Name -� <br /> o Samplers (Signature) Site Address <br /> NUMBER TYPE <br /> ti SAMPLE LOCATION DATE TIME SAMPLE <br /> (IDENifF7CAT10N} {NiFFUQAYIYR} (HO11Fi1MIN) (GRAB OR <br /> CONTAINERS COMPOSn E) MATMX REMARKS <br /> m100,b Qa4ve—, ** 8260 OXYGEMTES 01 <br /> MW — 7 0i <br /> Iz <br /> W OS <br /> n1 u1- S o6 <br /> 9 01 <br /> MW- Ia as <br /> MO) - I-30 IT 0q <br /> Il}u1- a �o <br /> 1�uJ- Co <br /> f))W - 3 {Z <br /> srtkm Z 4 q� WooTURNARO, NQ-'nM E <br /> c.c� 9k <br /> Refsrqulahed B)r(signature) DateTrima Recewd W(Signature) rxaudrene 24 HOUR ❑ <br /> 48 HOUR U <br /> Reim Wshw w(Signature) DatsTime Flecerued Ely-(Signature) aatemme 5 DAY, <br /> DISTRIBUTION OngkW Accompanies Shipment Canary Copy'Sherwood Pk*Copy Sampler NOTE Samples are discarded 30 days skier results are reported unless other <br /> arrangemarrts are made <br />