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A L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client V C`wN1GC[ rlrVl Rhone <br /> Address �' 13 GMK `.77-4 / CC to: <br /> Zip <br /> s-' <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest c rges 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 No ANALYSIS <br /> >r Coon. <br /> SAMRreEb BY: (signature): to s <br /> REMARKS <br /> sample <br /> type Sample Location <br /> Date Time m.o como <br /> DlleF ?A r OF <br /> Relis ed by( aLu re): ate /T/ime,/ Received-by(signature): ,.- -y j Date Time <br /> 1� � / �'' �/d '✓'I� iC:G'f" G%,��':-o.. .C.. !�G-G-L'c- / ����i�l �} l <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 /> 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 />