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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 /> t <br /> Tient_ 261Ee i�l (eqA z_ //Ulf _ Phone <br /> I Address P d. E�X _Z_,79:4 CC to: <br /> rzo6let. Zips391 <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to Interestcharges 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 /> PRbJECT IDA ,��� �/ Na ANALYSIS <br /> A of <br /> Con• V <br /> SAMP BY: i ature): tain- �� <br /> ers Q REMARKS <br /> Sample <br /> type Sample Location <br /> Date Time <br /> 1172 14UD &0 e ET/ 4( JA&C_ O A-r 0V7'LE7- /hl7-0 <br /> II STA ND P/PE <br /> q Z11I IC!!0 K WAST f7!'V1n1lA/fZ x A- PLr.D 4' 5"A/}7e'L_r P0QI <br /> i b10f >r rW,/5r SoWInAIVR D 2 <br /> Rel hed by I ure): �at / ,JTime R ived y(signa)ure): atq Time <br /> elinquishe (signature): Date Time R eived by(signature): Date Time <br /> f Relinquished by(signature): Date Time Received by(signature): Date Time <br /> r <br /> r <br /> Rel�nquished by(signature): Date Time Received by(signature): Date Time <br /> Rel squished 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 />