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}�... ers:Bna?�.' - :. P., ,,� • * _" �:y�;����r_',.�. a!si�`�^°� �. .�,__ ..� �.,_.,.r.a �-�xa .s.. .,� - aii4.i3+j <br /> L' <br /> k .--alitornia Water �-abs <br /> =r Address 'f r <br /> w X 4249 <br /> 1490 CARPENTER LANE <br /> r� MODESTO,CA 95552 phone No, <br /> PHONE 1209)527.4050 Contact PPrsan 4r/ <br /> (D 1pler.ee print) <br /> CHAIN OF CUSTODY RECORD <br /> PROJECT RAME: <br /> - 4 J <br /> :' ?lumber `F h. L) REMARKS <br /> SAMPLERS <br /> -'(Signature) !�� /-r {r J, a I A V <br /> of <br /> muumbern Date Tine Station Location tainei 's <br /> u <br /> if fir= <br /> V 1 <br /> f _ <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date / <br /> Time Received by (signature): <br /> Company or Agency: <br /> Company or Agency: Company or Agency: <br /> Company or Agency: <br /> Date / Time Received by (signature): <br /> Relinquished bY)signatu-,?): Date / Time Received by (signature}; Relinquished by: Conpany or Agency: <br /> ' Company or Agency: Company or Agency: <br /> Company or Agency: <br /> Time Remarks/Shipping Information <br /> R �ngvls ed i3 �n 6re); to 1 Time Received for Laboratory by: Date 1 <br /> J�.._� <br /> (tigpature) <br /> r 1 i <br /> {aapany or <br />