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A' WESTERN• LABORATORIES, INC. <br /> gig <br /> 1311 Woo Ave. <br /> #1. • Modesto, California 95351 Phone 209-529-4080, <br /> '•, ' <br /> o <br /> f 'SHAD CUSTODY 2524 <br /> f� <br /> Client OA410 -Ah-A SaW <br /> Phone <br /> Address CC to: dif✓N�✓ij1 Q <br /> Zip <br /> Signature of person authorizing work ', 148 T N <br /> under terms stated below" �•.N®XCA <br /> p +4 <br /> 'Net 30 days. All accounts past due will be subject to interest ch :irearges of 7.5% per month, / <br /> "Hazardous materials are ttg�rproperty 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 /> s <br /> PROJECT ID ANALYSIS <br /> No. <br /> :a Jo 04 J14`M of. 'R <br /> )j SAMPLED BY: na t3): il�. tarn" f <br /> . ern <br /> ' <br /> REMARKS <br /> sarn <br /> _ y <br /> vpe Sample Location <br /> elk Date Time <br /> q Grab Com°- J <br /> 1 1 l/S6 0 —�i �S X ]( -s <br /> .OWf3vs e —ll, —7) /X r <br /> kil X <br /> o .a s <br /> Ala gig 3g <br /> Reil ishe y(si�rts re): Date Time Received by(signature): Date. Time <br /> Relinq hed b (signature): ate time Receive y(signature):/ <br /> Date Time <br /> Relinquished by(signature): Date xtime Received by(signature): Date Time <br /> { <br /> Rehn'quished by(signature): Date Time Received by(signature): Date Time <br /> i <br /> Relinquished by(signature): r Date Time "Received try(signature):} Date Time <br /> A Site Time: <br /> Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br /> HIE <br />