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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client C��S 41% y <br /> Address f� ���r-'• y O X Z7�J• Phone <br /> / UROcc to: <br /> A zip. <br /> Signature of person authorizing work <br /> under terms stated below' <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 /> PROJECTID <br /> No, ANALYSIS <br /> L Wor <br /> SA P ED BY: i t re): ain . <br /> ers <br /> sample REMARKS <br /> j� <br /> type Sample Location <br /> Date Time a,an cam°. <br /> G /i3 a 3 F X <br /> Reh u" hed by(si n re): ate Time R eived by(signatu e): <br /> Date Time <br /> f I Relinquished b14 1 (141 <br /> gnal ate Time Received by(signate): <br /> J Date Time <br /> Relinquished by(signature). Date Time Received by(signature): <br /> I Date Time <br /> I <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Date Time <br /> Relinquished by(signature): Date Time Received by Date Time <br /> I Site lime: <br /> Driving Time: <br /> I Start: Finish: Total Hours: Start: <br /> Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />