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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 /> Client C �_-'5/ y r/LAA Phone <br /> Address_ h Q 9 X 37 2 CC to: <br /> R L 0-(- k1aA Zip'7S 3 0/ <br /> Signature of person authorizing work <br /> under terms stated below' <br /> "Net 30 days. All accounts past due will be subject to interest charg/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 /> t <br /> PROJECT 1D No ANALYSIS <br /> 51L ✓A co_ <br /> SAM P D BY: (s re): ern �t <br /> REMARKS <br /> sa pe <br /> type S ple Location <br /> Date Time G ac coma. <br /> 7/77- <br /> 14q 9 1 r. e6CA,4vN P�E44el7.4 X A?f 1PLFP A % <!05C ,f l ' <br /> I <br /> Relinq ed by(si e): pate Time <br /> Re ed by(signature): i Date Time <br /> . f it l� <br /> Relinquished by(signature): Date Time Re ivedby(signature): Date Time <br /> 4 <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 /> a� <br />