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& L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> A 3k <br /> CHAIN OF CUSTODY 143 <br /> Client GkkS$Al .y C ���u7L��� _ _ Phone <br /> Address F-0 - CSO X 3 / /Q __ CC to: _ <br /> zip �3�I <br /> - - <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 rges 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 ,` 2 No ANALYSIS <br /> DoNAV&AJ GH4✓ea of <br /> Con. p, <br /> SAMPI-EqTY� re): lain Q' <br /> ��(`/��'_�'�- ers r� Q REMARKS <br /> sample <br /> ,Ype Sample Location <br /> Date Time G,ab comp _ <br /> 2 Sf x .23 NN N KD. Y X Ani 7-4knl F(zo,,,l <br /> O 1S i �s <br /> X nl <br /> Relin ui hed b ): <br /> Qatef <br /> pTimJe Recei *(Slp�nat,'ure Date Time <br /> DRelinquished (signature) Date Time Re eivere) 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 /> l/ <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />