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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> i <br /> CHAIN OF CUSTODY <br /> Client CL/, Se roNSUL r/nle7 Phone 4 69- 1403" <br /> Address O B O�" 3 7 9 CC to: <br /> �p/2 L. Oc/< Zip S� / <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 No ANALYSIS <br /> l<SC TeAd<_G 0LNTE2a <br /> Con. <br /> SAMPLE BY: (si re): rain. <br /> era / �yf REMARKS <br /> 1 sarnole / v <br /> tv�° Sample Location p <br /> Date Time aub tomo. <br /> S 30 I OS x /�� X X <br /> 3=121710 X Z /.c/:1 X x <br /> 5/30 1715 X OFT - X <br /> Sao /7Zf X Z FTa X X <br /> I Rel' q fished by re): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Reo ived 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 />