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& L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> a <br /> CHAIN OF CUSTODY <br /> Address Phone��� / i ';Z - � - ^ <br /> /'l V <br /> 7 <br /> cc to: <br /> zip <br /> Signature ot person authorizingw�rk/ ZV <br /> ander terms stated below' <br /> 'Net 30 days. All accounts past cfue 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 /> PROJECT ID ANALYSIS <br /> of <br /> SAMPLED BY (signatur —" con- <br /> s r^- lain- <br /> + ' ers <br /> -'srtGr so y REMARKS <br /> Sample Location <br /> Date Time <br /> �-. <br /> t.- V✓ <br /> Relinq uisp ed by(signature)oI ,.� Da? Time Received by(signature): Date <br /> Ton- <br /> 7- <br /> ime7. y,O <br /> .._ . 'Retro uished by(signature): Date <br /> Time Received by(signature): Date Time <br /> Rehnquisned oy(signature): Date Time Received by(signature). <br /> Date Tits= <br /> Relinquished by(signature): - - Date Time <br /> .--. Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Date Tima <br /> — Slta Time: <br /> Driving Time: <br /> Stan: Finish: Total.Hours: Start: <br /> Finish: Total Hours: <br /> Water Sample Chain of Custody/Analysis Appendix B <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />