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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-5294080 <br /> CHAIN OF CUSTODY <br /> Phone <br /> Address a' ✓, O X S % CC to: <br /> 1 Ilii Ulkl- Zip? = ; <br /> r� <br /> Signature of person authorizing work/ <br /> under terms stated below' 4 '�Z - c <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 /> (-7 "if r< r rV of <br /> Con• <br /> SAMPIt#D BY: (si ature): tarn- <br /> ers <br /> } REMARKS <br /> satrffile <br /> type Sample Location <br /> Date Time c,a, lcp p. <br /> a r k '� VPt C 7 FT <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signati.re): y 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 />