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Qal <br /> pari ter Labs <br /> P.0.BOX 4249 <br /> 1430 CARPENTER LANE Client <br /> MODESTO,CA 95352 Address <br /> PHONE(los)527-4050 Phone No. JS2o/ <br /> CHAIN OF CUSTODY RECORD Contact Person <br /> (Please print)rsnprinij <br /> PROJECT NAME: <br /> 044 en �� <br /> S S (signature) <br /> C Number �s�o <br /> Stat on of REMARKS <br /> Number Date Tim¢ cL <br /> Station location Con-. <br /> tainers / [,- <br /> 3 <br /> 1 3v 7 � 9 <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date <br /> / y (signature): <br /> Company or AgTime Received by <br /> Company or Agency: Company or Agency: <br /> Company or Agency; <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received b <br /> Company or Agency: y (si gnature): <br /> Company or Agency:' Company or Agency: Company or Agency:- <br /> R uish d b a re): Dae / Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> o A e ?natural/� ;-17 ,L? <br /> 3• <br /> rej <br />