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1 <br /> A & I� MESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 * Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> E <br /> � 1 <br /> Client. +"tESA) E e621111V -Ti,N[_ _ Phone <br /> Address p d 7 CC to: i <br /> zip q53�? — <br /> I <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest charges of 1.5% per month. <br /> `Hazardous materials are the property of thelclient. 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 ` No ANALYSIS 4 <br /> ,8U4 LF2aC <br /> Con- <br /> SAMPL BY: (3' fain tura): � ars Lr v� � 4/ <br /> REMARKS <br /> sample <br /> type Sample Location <br /> Date Time c.ecoma. . <br /> �S /! 0 X WE r eaAt !fe`.AAl0 D x X X X K X WE LJ, 5A M PI-F-0 <br /> 'I m F p ,Ar V 4c _ or 0P <br /> Y <br /> , <br /> Rived�b�y(sign <br /> / tuP.r_aG):� Date1�7Tii mZeReli had Sure): qy 7 <br /> Time <br /> Relinquished by(signature): i Date Time R eived by(signature): Date Time <br /> Relinquished by(signature): " Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> l <br /> Relinquished by(signature): i Date Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> r <br /> Dedicated ExClusrvely to Providing Quality Analytical Services <br /> � �I <br />