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CHAIN OF CUSTODY RECORD 801743_ -`y joo <br /> 51werwood 8071 N. Lander Avenue <br /> Q <br /> P.O. Box 937 � <br /> Hilmar,California 95324 Lo <br /> Labs (209)667-5258 A n. Phone: <br /> C O R P o A A T ! O N FAX(209)667-2581 ^'` i/r�rse L� Page flf <br /> co <br /> w <br /> Job Number: PO.i Pmol Name <br /> Sam I :(Signal ) / Silo Address <br /> SAMPLE SAMPLE NO. l <br /> NUMBER DATE TIME TYPE SAMPLE INFORMATION OF REMARKS � <br /> CNI <br /> Swe 11!KV 411011 /6 / C v <br /> f H <br /> O <br /> O <br /> O <br /> fn <br /> iTJ <br /> O <br /> t7 <br /> M <br /> N <br /> O <br /> (0 <br /> CO <br /> W <br /> U1 <br /> 07 <br /> Relin hed gy1 C§ignatute) mlerlrl geoeir@d By;(Signalure).- ca me Ship via: <br /> Relinqu� ed By:(Signature) Dat me eceivt�d Sy:(Signatutd) at irno' <br /> TURNAROUND TIME' <br /> Reknyuished By:(Signature) D.1t–; a Aecek%d By Laboratory =-e ❑24-HR 0 484iR ©5-DAY ©1 O.OAY <br /> OISTRIDUT:ON',Original•Accompanies Shipment Canary Copy•Shernrodd Pink-Sampler NOTE:Samples are discarded 30 days after results are reported unless dlher arrangements are made. <br />