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F 4. <br /> WESTERN LA O ATRIES, INC <br /> i 1311 Woodland Ave, #1 © Madeswo California 95351 0 P _ <br /> Phone 209 529-408 <br /> 0 <br /> CHAIN OF CUSTODY • <br /> �r <br /> Client ! <br /> Phone <br /> Address <br /> � GC to: <br /> A,gz)l0e,.r Zip <br /> F ' Signature of person authorizing work — <br /> under terms stated below' <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 /> PROJECTID <br /> ry No ANALYSIS <br /> G% /Va v of <br /> Con- <br /> SAMPLED <br /> ure):, tain. <br /> M1 ens '1 <br /> i" REMARKS <br /> • <br /> Sample Location Lj� - <br /> Date <br /> .� >-Z30 y � <br /> f 1 <br /> "0 l rir� 57 <br /> F r <br /> 1 <br /> F�i <br /> TEI <br /> 1 Relinquished by(signature): Dae Time Received by(signalure): . Date Time <br /> Relinquis ed by(signature); Date Time Received by(signature): Date Time <br /> ' I <br /> Relinquished by Isignalure,: _ Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature). Date limn Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> StartFinish," Total Hours: start: Finish: Total Hours: <br /> k <br /> Soil Sample Chain of Custody/Analysis 11I <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />