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A v& L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 o Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client if H e�+K F V rD lJs i r z/lj�� Phone <br /> Address d ' lJ O,t :7/of CC to: <br /> j.. a LO C^ V /�CA Zip %-c��11 <br /> Signature of person authorizing work ' <br /> under terms stated below' Lir. <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 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 /> cot <br /> on- <br /> SAMP BY: (s ature): tam- '� P <br /> A- / � � ers �/ �(1" REMARKS <br /> sample <br /> type Sample Location '*1 <br /> Date Time GaD Comc <br /> 172d /,R0 Al 4 5,6EEIQ DA t <br /> NEW ,-- —rtz N rLuN0 OL bfJ- <br /> P? r A/, 9 l/Fo-J A O. X <br /> 11' S� /V. Po/v 2 iD. I / <br /> ReInq ished by(slure): D te/ Time Rece}ved by(signature): Date Time <br /> Relinquishe 6y(signature): Date Time Re/eived 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 />