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L WESTERN LABUgIATOMES, INC. <br /> 1311 Woodland Ave. #1 o Modesto, California 95351 Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client Phone <br /> t Address I �— I ` %f..'.J CC to: ! "yl �. <br /> Zip <br /> Signature of person authorizing wgrk, �� <br /> under terms stated below' :�1`" - ��`•-- r'r'•`: <r <br /> 'Net 30 days. All accounts past Cue willbesubject to interest charges of 1.5% per month. <br /> F <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 ANALYSIS <br /> No. <br /> �_� ��� _. L/ of <br /> Con- ty <br /> SAMPLED BY: (signature): Iain- <br /> REMARKS <br /> + i sample <br /> type Sample Location <br /> Date Time ccmv" <br /> "V <br /> E. <br /> i <br /> Relinquished oy(signature):_._.__...�"– Da}e Time Received by(signature): Dale Time <br /> Relinquished by(signature): ✓ Date Time Received by(signature), Date Time <br /> Relinquished by(signt:.ure): Date Time Received by(signature) Date Tirne <br /> Relinquished by(signature): Date Time Received b si nature <br /> Y{ 9 1 Dale Ti,n_ <br /> C!o Relinquished by(signature): Date Time Received by(signature): Dale Time <br /> r. Site Time Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Water Sample Chain of Custody I Analysis Appendix ;5 <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />