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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> w��.0•:tea.ucusew <br /> CHAIN OF CUSTODY <br /> Client �" J� 9� Qf'� ����r Phone 'Id_ <br /> AddressCC to: <br /> U,7L C CA zip 153V <br /> (� Signature of person authorizing work <br /> r- under terms stated below' <br /> 'NeE 30 days. All accounts past due will be subject to interest charges of 1.5% per month. <br /> rnateriaJz ,.... , . _ p <br /> picking oup h'- dolusawastespmayebe asse sed and pp7oplr aleJeeesponslble..for roper disposal of hazardous wastes.Clients not <br /> l^�r(�J yry <br /> PROJECT IDNo ANALYSIS !, <br /> ofIV 7-15 ty <br /> Con. (V <br /> SAM�Ep BY: i attire}: fain- "(C_� <br /> ers REMARKS <br /> ampie "J <br /> 10A, <br /> 1yp8 Sample Location � \ <br /> Date Time c ao tomo. <br /> k � rS i✓ f <br /> II <br /> ,s X33✓ X9 F7— 7� <br /> l <br /> r f 1fI � 41 <br /> I A 1 1"7 LLL <br /> Relin d by(sig r Date Time Rec ed y(sign ture): D te� Time <br /> Relinquished by( ignature): Date Time Rec ived by(signature): ate 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): pate Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Flours: Start: (=finish: Total Hours: i <br /> Dedicated Exclusively to Providing Quality Analytical Services <br /> !� i <br />