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f A.-•& L WESTERN LABORATORIES, INC. <br /> J <br /> tL 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> r <br /> CHAIN OF CUSTODY 2567 <br /> ` Client Phone rJOar' J s <br /> 4 \` Address_ 7 0 J __L ._ . G 1 A/n CC to: �M x f LGA,/__..-1 ;L"_t[y L <br /> v1 aosiv _ C� - zip 5-35Q 1-419-14 14 '1�Y yt/4y i <br /> t Signature of person authorizing work C '� -- ajV 0_.�� _�2 953 d <br /> under terms stated below' r' <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 the client. The client is responsible for proper disposal of hazardous wastes. Clients not <br /> I picking up hazardous wastes may be assessed an appropriate fee. <br /> IPROJECT ID <br /> .� No ANALYSIS <br /> Vfl p of <br /> Con- <br /> SAMPLED BY: i nat twin• <br /> ers REMARKS <br /> sample <br /> type Sample Location <br /> Date Time craa c—,. <br /> I X lG <br /> 5 ! 11:LG 7f �� W. — Z X <br /> I <br /> Re rngpished by(Sig to e}: Date T4,nni�,, _E �in d'b signature)- Date Time <br /> Relinqu shed b (signature): Date Time Re ived by(signature): Date Time <br /> i <br /> Relinquished by(signature): Date Time Received 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 /> i Site Time: Driving Time: j <br /> . Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> I <br /> i <br /> Dedicated Exclusively to Providing Quality Analytical Services I ' <br /> Sec III, C 1 f <br />