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VM-" <br /> :w g4^ arta 7gid `r -r+'srg,�a+maru•.n+n,.r :rug <br /> .. <br /> A , L WESTERN ''LABORATORIES, INC. <br /> 1311 Woodland Ave 41 * Modesto, Califomia 95351 • Phone 209-529A080 <br /> CHAIN 01= CUSO:DY <br /> Client C l`vl _ �! <br /> t�l L f//iJ/, Rhone - 1i <br /> Address ' "f CC to <br /> CU.P. G 0 .4 ZIp <br /> Signature of person authorizing work r <br /> under terms stated.below' <br /> 'Net 30 days.All.acco.unts past due will.be subject to Interest char ,s.of`;.1;5%o,per month. <br /> 'Hazardous materials are"the property of.the client The"client rs..responsible for proper d.lsposal of hazardous wastes,Clients not. <br /> picking up hazardous waMes;may be assessed 4m,appropnate.fee <br /> PROJECT ID .. <br /> NO.' <br /> ANAk YSIS <br /> � <br /> Con <br /> SAMP Q BY: (sig ure): tarci <br /> ,r ,{ REMARKS <br /> sample <br /> �rpe" Sample Location <br /> Date Time <br /> , <br /> ` r' 7 F .?`- <br /> "r: �5-F, <br /> , <br /> i I <br /> Reli q s#te7jd by(si re) Jr/y��te Trine Recfi}ved by(signature)", Date Time <br /> Relinquished b ft gnature):: : . Date Tr me :_ :RecelG6d by('signature): Date Time <br /> Relinquished by(signature):. . Date `Time, Received by,(sig'nature):. Date, »:Time <br /> t :. <br /> Relinquished by(signature): ., Date Trine Recervedby:(signature):', '.Date Time: <br /> Relinquished by(signature):. T-Date-- ""'Time, Received by(signature):. i.Date Time <br /> Site Time: Drrvrng.Trme: <br /> Star[: Finish: Total Hauls ;Staff Finish: tours:. <br /> Dedicated Exclusiv.Ply to'Provido Qualfty'Analytical Service's ` <br />