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I <br /> �� aV A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client Phone <br /> Address 2 60 k ~ 7'14 CC to: <br /> f G <br /> oz,(/" C/1 zip ' "1 <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 IID No ANALYSIS <br /> /(_F-� of <br /> SAM. LED BYCon- <br /> ,.(�1 nature): twin" f� <br /> ers REMARKS <br /> saaammlp ample <br /> Sample Location <br /> 4DateT�imeGrab"pe <br /> Comp. <br /> Relin shed by(sX'2a re): Date Time Received by(signature): Date Time <br /> /. L/�" q, <br /> i int �• !<D �iJ 7 ? �- <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 />