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A �& L WESTERN LABMATORIES, INC. <br /> AtL 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client CN�SNEy �ONSU�T/NCS Phone �69�"(40 <br /> Address d 13QK3 /q!+- CC to: <br /> zip S I <br /> Signature of person authorizing work <br /> under terms stated below' - &J92' - <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 No ANALYSIS <br /> MAT s - <br /> SAMPL BY: (si t ): tain- <br /> ers �(/ REMARKS <br /> sample <br /> type Sample Location r1 <br /> Date Time Gob comp V <br /> 7 fi 6nJ !( Irt,/. UIVLTE x <br /> f7 /boo x950 Id. ScNul-re X <br /> R"hedbyturet Date Time et ed y(signat�re): D to Time <br /> Relinquished by(signature): Date Time Re ived 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 /> R ;inQqished 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 /> :. �... a.s.11-.-...,fi.�.�,.a...::i�a.:.....,,il.'.,.fv�uuw .. ei� w �:•;.�.�:;r..�.__:_.1.,._. <br />