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IV& L WESTERN LABORATORIES, INC. <br /> AIU 1311 Woodland Ave. #1 *,Modesto, California 95351 • Phone. 209-52974080 S <br /> CHAIN OF CUSTODY <br /> Client t"s NG W�vSu� f1�� Phone moils �—` 23 <br /> Address, • �� ! r CC 1o: <br /> Signature of person authorizing work <br /> under terms stated below- <br /> in,30 days. All accounts past due will be subject to interest ch es of 1.5% per month. <br /> `Hazardous materials are the property of the client. The client is responsible for proper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECT IDp , I CNo ANALYSIS <br /> 1%11 7- 7 of d <br /> on- <br /> SAMP BY: (Si re): fain- <br /> REMARKS <br /> sample <br /> lyPe Sam le Location <br /> Date Time Oraa CMM <br /> o �4r W- 2 w15rr OIA/4 4211 gam' <br /> �. <br /> 4 <br /> }C v 13 1) �C r� <br /> F Wl A/ l�► FP i <br /> o <br /> W- 1Z { X r ax rn! Z <br /> ge— <br /> D /O00 X f Y, : ADRiN l¢ E <br /> Wesr agIzzA14 7A b 66 <br /> 0 14930_X <br /> Re .q fished by re): ate Time R t;ceive by(signature): [Date. Time. <br /> I2 / rW a I <br /> Relinquished by faignature):' Date: Timeeived by:(signature) Date..' Time <br /> Relmquishedby(signature) Daie,° Time" Received by(signature) : Date Tune. <br /> k <br /> Relinquished by(signature} . 4 Date TFme x Received by(signature) Date Time., <br /> Relinquished-by(si( rqa ure) <br /> n 'Date. ' Tlme' Received by(signature) Date Tlme 5 <br /> Site Time <br /> k Driving Time:, <br /> Start` Total Hours r <br /> Finish Total Hours Starr: Finish <br /> r p f <br /> Dedreated,Ex,clus►vely .to. <br /> f?rovrding'Quality Analytical Services <br />