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..... ..... <br /> U 1311 Woodland Ave. #1 ® Modesto, California X5351 Phone 209-529A-080 <br /> CHAIN OF CUSTODY <br /> 41 A <br /> Asia <br /> Client a S '].D,I'u pe_S 1-1 l� Ph+one: � �� <br /> 1 <br /> Address U 3 'E� �c�ci tAu 11- u �¢.S �� . <br /> CC to: <br /> Ni U Q pr � ' <br /> �� zip <br /> Signature of person authorIizing.work ✓� i�~^ � �+ C14 <br /> under terms staled below' <br /> Net 30 days All accounts pastwill be subject to interest coarges of 1.5% per:�rnonlh. <br /> 'Hazardous materials are the.property of the client. The client is,responsible for proper disposal of hazardous wastes. Clients not <br /> 444 picking up hazardous.waste s;may.be"as sessed an appropriate fee. <br /> PROJECT iD <br /> No. ANALYSIS <br /> 7 ofCon- <br /> c <br /> SAM ED BY: (signator tain- <br /> ers REMARKS <br /> a <br /> type Sample Location <br /> Date Time o,ao tomo. <br />. F` - - <br /> ' <br /> V/0 12.00 vV <br /> iC> , - <br /> i <br /> t <br /> F44i <br /> i f <br /> f 9 <br /> Reiinq 's ed signator -�' Date Time Re 6iv d y(siq�na�ure};`: Date Time <br /> Elm ui5 ed by{signature}: Date : Time Flea Med-by.(signature): Dale Time <br /> i <br /> Relinquished by(signature): Dale Time Received by(signature): Date 7irne <br /> Relinquished si nature: Dat <br /> Q y( g ) e Time Received by(signature): . Date Time <br /> Relinquished by(signature): Dale Time Received by(signature) Date Time <br /> Site Time: Driving Time; <br /> Start: Finish Total Hours: Start: Finish; Total Hours <br /> } Wates Sample Chain of Custody / Analysis Appendix B <br /> I Dedicated Exciusively to Providing Quality.Analytical Services <br />