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0Z - 0S2 -03`1 <br /> @AD x & L WESTERN LABILMATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-5294080 <br /> CHAIN OF CUSTODY <br /> ClienteaA/ S"Z-n" Phone <br /> Address ��J�d gOX 37.9 CC to: <br /> /uRLOL/�, Zip <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest c arges 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 ]1KM <br /> C V G of <br /> Con- <br /> SAMP D BY: lure): tain- <br /> ersREMARKS <br /> sample <br /> �rpe Sample Location <br /> Date Time c„e comp. <br /> bJO s,Z�r 532- <br /> a 6 L F A 53220 <br /> ao IVo X LF-7 53221 <br /> Relinq h by(si t D a to Time Re d by(sign t e): ¢� Time <br /> Relinquished by(signature): Date Time Receive0y(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 />