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V <br /> ffffg �► & L WESTERN LABDAATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> �� CHAIN OF CUSTODY <br /> � _ ego - CLl(i <br /> Client ESNE� /LTi/l/� Phone 1pftr��0� <br /> Address �P a. 3 7 4 CC to: <br /> Zip q_f-3bl <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest charge 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 ID No ANALYSIS <br /> l- ✓`jof <br /> Con- <br /> SAM P D BY: (si re): tain- <br /> ers REMARKS <br /> sa pe <br /> type Sample Location r <br /> Date Time p,pp ic.mp. <br /> 112,1 !60 A 5 / l0 21 S <br /> /p3o X �S 7 Z( <br /> Re lin hed by i ure): Date Time Rec q e (signature): Dat Time <br /> � elf,/ <br /> Relinquished 6y(signature): Date Time eceived by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />