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A(4 L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 2079-529-4080 <br /> CHAIN OF CUSTODY <br /> Client { sAI CV ��1t1�u�T/��(� Phone --- <br /> �- D ' ?� 7 CC to: <br /> Address_ ��..., <br /> zip <br /> t <br />! Signature of person authorizing work <br /> under terms stated below' 4,141 19.e"e <br /> `Net 30 days. All accounts past due will be subject to interest char es 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 /> PROJECTID No ANALYSIS. <br /> oCon. <br /> SAMPL BY: (sig re): twin• <br /> �` ers ��, REMARKS <br /> i� Y• <br /> sampl `b <br /> type Sample Location d <br /> Date Time Grab" CamO <br /> 4j= <br /> 1200 x 20 it r <br /> I <br /> 1 X W, <br /> ! two X <br /> Relin is d by(S'9 j ): pa)e Ti mle Re ce d bby(siggnpture)- Date Time <br /> Relinquished by 6ignature): nate Time Re " ved 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 />