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Cal iorni r Labs, Inc. <br /> P.O.BOX 4249 <br /> 1430 CARPENTER LANE—SUITE G <br /> MODESTO,CA 95352 <br /> PHONE(209)527.4050 <br /> CHAIN OF CUSTODY RECORD <br /> PROJECT NAME: 5an J"U 1/1>'j 01D, <br /> 4a,4-n4a,4-neq L n. Lan dl. <br /> S ERS signatu ) <br /> Number <br /> of REMARKS <br /> 63fation <br /> Number Date TimeCon— <br /> Station Location tamers <br /> P sec � ached she a recd �(�{ 31 � <br /> .3'.I'D X M w_ / � X vti `� <br /> ay 11.x° �v <br /> P. <br /> inqu hed by( gna re Date / Time Received by (signature): Relinquished by(signature): Date / Time Received by y (signature): <br /> any o Age y: aZy Company or A A <br /> $ Agency: Company y or Agency:y: Company or Agency: <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: Company or Agency:' Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Company or Agency: (signature) 5110 <br />