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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 9 Modesto, California 95351 • Phone 209,529-4080 <br /> CHAIN OF CUSTODY <br /> 328 <br /> Clienl /�� � Phone _ f } " 6/0�+ <br /> Address t✓ CC to: <br /> L! G� <br /> zipl <br /> Signature of person authorizing work <br /> under terms stated-below" <br /> 'Net 30 days. All accounts past due will be subject to interest Char sof 1.5% per month. <br /> 'Hazardous materials are the-property of the client. The client is esponsible for proper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECT ID No. ANALYSISof f <br /> 1 � Con- <br /> SAMPLED,BY: (sign t re): tars REMARKS <br /> i sample <br /> lrpe Sample Location <br /> Date Time Grab tomo. <br /> 1`/t log, 3e 3 F T / <br /> / - <br /> Reli u shed by n tore): D to Time Rec 'ved by(signature): Date. Time <br /> w.{ <br /> Relinquished y(signature): Date Time Regeived 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 />