Laserfiche WebLink
.7 <br /> California Water Labs <br /> P.O.BOX 4249 Client <br /> 1430 CARPENTER LANE Addre <br /> MODESTO,CA 95352 <br /> PHONE(209)527-4050 Phone Nor__)';M) JJ <br /> Contact Person <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: LiTi* Wmq-�_uj <br /> go, I ot�-V k-61- pj�U-T 61A-LI <br /> SAMPLERS (signature) <br /> Number <br /> REMARKS <br /> of <br /> Station Con <br /> Number Date Time A St&Qn -Location <br /> tainers <br /> Y\ <br /> '15.QL <br /> Relinquished byZ(signature Date Ti5pAeceived by (signature): Relinquished by(signat Dai I Received by (signature): <br /> 'cy. <br /> Company or Agency; Company or Agency- , Company or Agency Company or Agency: <br /> Relinqui'tied by(signature Date Time Received y (signature): Relinqui eeby: ate Time Received by ignature): <br /> s i>gn a t ur'e Received e v y <br /> 'ej m y <br /> Cpm;>any or Agency- Com ny or Agency: Comp :y2o"r Agency: Compan or Agency; <br /> Relinquished by(signature): Date Time Received for Laboratory by: Date / Time Remarki/Shippin'9 Information <br /> J nAa ncyi­ <br /> # - I I (signature) <br /> S54 n , r".1 11:1R /1"' <br />