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ffALD *,ft & L WESTERN LABLvAATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-5291080 <br /> CHAIN OF CUSTODY <br /> /� U 2-ci Z7- Io <br /> Client c.f/ESNEl/ &57NScctTinlG7 Phone lag-/4-o 3 <br /> Address ` 61. CC to: <br /> LCJ L GA zip IIS-301 <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 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 ID No X4/ <br /> I ✓ LE CSO S C O °f <br /> Com <br /> SAMPL BY: (sign r ): Iain- <br /> ern REMARKS <br /> sample <br /> 11P Sampl Location Date Time o,.b comm. <br /> � /20 X /40 1 <br /> 1 X zro <br /> 0 ®moo <br /> 13as X N/ X <br /> 672r1S <br /> I of X52x <br /> Reli shed by i re): Date Time eived by(signature): Date Time <br /> 2� o: /40o ''' z-1--Cz a: oc <br /> Relinquished6y(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 />