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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 Phone <br /> Address ` 0,-2)( 7&1 CC to: <br /> lEli k7 .62 zip <br /> Signature of person authorizing work <br /> under terms stated below' 4a A4�� <br /> *Net 30 days. All accounts past due will be subject to interest c rges 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 IQ ANALYSIS <br /> of <br /> SAM P SY: (si ure): tain- <br /> ers �(� �� REMARKS <br /> sample \v <br /> lype Sample Location <br /> Date Time Arab comp. <br /> 11.4 s x MY x x /Vo1Z709A57- 2I-r PE,,,- <br /> 91 v x . <br /> V 9 s v )c C- 5 x x 1� -157 „ <br /> avv y syya/0 / " <br /> l <br /> a <br /> Rell u' hed b n re): �i�`at Time R ived by(signature): Date Time <br /> mquish by(signature): 'Date Time R eivedby(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 />