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r <br /> s �e4 <br /> _19 ry L WESTERN LA DkATU I , INC. <br /> I 1311 Woodland Ave. #1 o Modesto, California '95351 ®''Phone 209-529-11080 <br /> CHAIN OF CUSTODY <br /> A <br /> Client . Me_,;_ Phone _1 <br /> Address ��// R <br /> CC to: Iva c A;r y <br /> Zip '7 `-!) 12 17 2 U <br /> Signature of person authorizing <br /> under terms staled below`` <br /> M. <br /> Nei 30 days. All accounts.past will be subject to interest charges of 1.5% per'morth. <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 IQ No. ANALYSIS <br /> f <br /> of <br /> Con. <br /> SAM BY: (signator ) � ��' tain- <br /> �� ers <br /> O, REMARKS <br /> sample <br /> type Sample-Location <br /> Date Time ,a� comp <br /> ) <br /> 2-- tf <br /> Mfr 7' ) <br /> Y <br /> t� P V <br /> r <br /> i <br /> L Reiing4 ed (signatur .p Date Time Received si nar <br /> r �y f 9 �'u e). Date Time <br /> Ell <br /> Rel nquisned"by(signature): Date Time Received t3y(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> t Relin uished b (signature): D <br /> 4 Y ate Time Received by(signature): <br /> Dale Tire <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Site Time Driving Time: <br /> Start: Finish: Total Hours: StartFinish, Total Hours <br /> Water Sample Chain of Custody i Analysis Appendix B <br /> ' Dedicated Exclusively to Providing Quality'Analytical Services <br /> i <br />