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i <br /> I M`�- L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 ® Modesto California 55351 0 Phone 209-529-4C80 <br /> �. CHAIN OF CUSTODY <br /> Client Tv1N �JCl� iti <br /> G, _ Phone <br /> Address /O L �/JD <br /> CC to: <br /> Signature of person authorizing work _ <br /> under terms stated below'` <br /> Net 30 days. Ail accounts past due will be subject to interest charges of 1.5% per month. <br /> 'Hazardous materials are the property of the client. The cllent Is responsible for proper disposal of hazardous wastes Clients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECT IDNALYSIS <br /> /W Np of A <br /> Con. <br /> SAMPLED Ely: (si nature):, tain- <br /> ers REMARKS <br /> sampla ('�� <br /> type Sample Location `y <br /> Date Time c,e camp. <br /> a <br /> � 30 rte•3° k <$ w�', :^ . <br /> a:4r 57�% <br /> 5-7 <br /> i <br /> �aM r <br /> is <br /> Relinqulshed by(signature): Da Time Received b si nature : <br /> Y I 9 } Date Time <br /> eRelmq s ed by(signature): Date Time Raceived by(signature): Date Time <br /> !!! Relinquished by(signature): Date Time Received by(signature): Date Time <br /> ti <br /> Relinquished by(signature): Date Time. Received b si nature <br /> Y( g ) � Date Time <br /> Relinquished by(signature): [Date Time Received by(signature): Date Time <br /> Site Time Driving Time: <br /> Start: LFinlsh^;'.; Total Hours: Start: Finish: Total Flours; <br /> Soil Sample,Chain of Custody !Analysis <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />