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Y <br /> & L WESTERN LABO'hATORIES INC. " <br /> 1311 Woodland Ave. #1 • <br /> Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client Phone CG Id g— ISI©� <br /> Address_ <br /> CC to: _ <br /> / //k Zip S /� <br /> Signature of person authorizing work <br /> under terms stated below` (.�J <br /> 'Net 30 days. All accounts past due will be subject to interest charges of 1.5% per month. <br /> "Hazardous materials are the property of the client. The client isrresponsible for proper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> I <br /> PROJECT ID No. ANALYSIS <br /> l?r. - WA t /,�_U <br /> of <br /> ��� <br /> SAMP)_ED BY: ignature): tain- ,( <br /> ers <br /> REMARKS <br /> sample <br /> Date Time type Sample Location V <br /> G,ab Como. <br /> '7F j T <br /> 5, L ZEA <br /> 1 y <br /> 77, <br /> Relin i hed by(s g' ture): /(D pto Time ry Rece ed by(signature). Date Time <br /> i <br /> Relinquished by(signatu7e): Date Time Redived by(signature): Date` Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time II 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 />