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L VI EOERN- LABORATOR#ES, INC. <br /> ,M <br /> 1311 Woodland Ave. #1 4 Modesto, California 95351 • Phone 209-529-0080 <br /> CHAIN OF-CUSTODY <br /> Client Phone _ &Q,26 403 <br /> Address. ' ' CC to: <br /> e,d(�1..0U SGA zip��._ <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 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 Ido. <br /> !ANALYSIS/ <br /> of } <br /> Con. k <br /> SAMPt. D BY: ( ' nature): lain- 1('° <br /> ers ��" REMARKS <br /> sa pie �\! <br /> type Sample Location ' <br /> Date Time 'Grab 1COMP <br /> k «� <br /> 1-770 K 2-d . 'I <br /> _X1 X1r <br /> .A <br /> I <br /> i <br /> F <br /> isle <br /> Relinq h d by n(se): r Time inq h d-by imeReceived by(signature):// Date Time <br /> j t4l <br /> Reiinqui ed by signature): Date Time ReO_ ived by(signature): Date Time <br /> Relinquished by(signature): Date Tirme 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 <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours <br /> Dedicated Exclusively to P'r'oviding Quality Analytical Services <br />