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UMVERSAC <br /> ENGINEKRING <br /> INCORPORATED <br /> SAMPLE CHAIN OF CUSTODY / WORK ORDER v <br /> Client's Mame Phone` � �� � <br /> i Address <br /> City, State,Zip ` <br /> Client's or Representative's Signature <br /> (signature authorizes the work and terms listed be ) <br /> 'Terms: Payment is due within 30 days of Invoice, A service charge of 1.5%will be added to overdue accounts` <br /> "All samples remain the property of the client who is responsible for disposal.A disposal fee may be Imposed if client fails to pick <br /> up samples, <br /> P110i NO PrtUJECT NAME <br /> NO <br /> S021CON- HEMA11Ky <br /> $i A NQ ;A TIME STATION LOCATiUN TAINESS <br /> U <br /> l• I <br /> b,GSC r .5i✓ <br /> -y7 1416 a it - Sa.•+ fc SE <br /> I 61:f /VE <br /> r <br /> r • <br /> rtel—quitlReQ by 1$.�.srure) Date Time FIP6elve9y Mo,,erwe} DRIJING TIME ` <br /> �. b4MIT '" IUJL':Et r0T7ft'N <br /> 4 _ia,gvyn7 <br /> d by 15.ynnli,i e) pale T+n1e Re40ivdJ by (S,yndrwel SITE,TIME <br /> STAII4T. FINISH, TOTAI, <br /> 5 <br /> e:mhp,ish,r.l by 13yn�ta,u) U.rl• rums Ilotipvud by I�+pnarWAJ FUTAL IIML T l U,,I SOW1,MILE <br /> MILEAGE, t. <br /> P.Q. Box 5853 • Concord. California 94524 • (707)746-66991FAX(707)746-61315 <br /> S0 - d 6S — t- — 11ny <br />