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AtLlA ' L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-40SO <br /> CHAIN OF CUSTODY <br /> Client_('L��sh1E(/ eON!W if r/nuc Phone <br /> i . > <br /> f Address ,� aX 379 -- CC to: <br /> a [_O CAr l <br /> Zip S.� <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due willbe subject to interest ch ges 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 /> f_ <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECT ID No. ANALYSIS <br /> of <br /> Con• <br /> � <br /> SAMP D BY: fain- <br /> tune): ars Q [REMARKS <br /> ample <br /> type Sample Location <br /> Date Time Oren coma. <br /> t I aot X 7 At P1 ME D. <br /> o 126r x 7 A i Pi tJr iz b / k <br /> I � <br /> I <br /> # + c vedb (signature): Dat <br /> Reli ui hed b ure): ate Time Fje e fy q Time <br /> I,�30k 2-5-91 <br /> Relinquished by(signature): Date Time Rer�6ived by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> ROnquished by(signature): Date Time Received by(signature): Dale Time <br /> ` Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: f=inish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br /> r <br /> l , <br />