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/X► & L WESTERN LABORATORIES, INC. <br /> 6A 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client CSI Phone (Clo <br /> Address P• DK �,�r?'4 <br /> CC to: <br /> �Glr? Lrac/r �� Zip gr it <br /> Signature of person authorizing work �j / q,t // <br /> under terms stated below' ll•5r rt �' <br /> *Net 30 days. All accounts past due will be subject to interest charg sot 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 ANALYSIS <br /> No. <br /> SAMPLEDCon- <br /> , BY: (sig.�f/ re): tain <br /> REMARKS <br /> sample <br /> type Sample Location <br /> Date Time ciao conn. <br /> }� u <br /> S t <br /> Relin s e by(sig ate Time 6celved by(signatur/e):. Date Time <br /> ,i Jz7 , ' l3 alt , ✓' �.e '� 1:Y l l <br /> Relinquished by(signature): Date Time R ceived 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 /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />