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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 I.. t9 Iy iA E^+J/SL AV _ Phone S-1-103 <br /> Address l7 .V --7all CC to: <br /> j <br /> —_.. —rA zip <br /> Signature of person authorizing work _ <br /> under terms stated below' iZ�kf <br /> / ✓ <br /> 'Net 30 days. All accounts past due will be subject to interest chges 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 ID / �r ANALYSIS \' <br /> /AC 4. E7,/�L� Nf ` <br /> of 7L <br /> + Con- Cyf/ <br /> SAMPL eY: (si �A re): lain i� <br /> UOi '7j ers �q V hREMARKS <br /> sample <br /> type Sample Location <br /> Date Time cme JCo111l� <br /> i Itzoo ,R W u F L F=' x I X I I 412011AIPW,47T-,> O.V U<,k' <br /> /Zrly /;'Vo le I A3RowyJ / A k,5 y <br /> 171—tl 1S10 X ggo nt dF l eC wr1 Z c l X <br /> Reli uohed by( f re): Date Time Received by(signature): Date Time <br /> i <br /> -44,f <br /> /=J�fa� <br /> Relinquished b (signature): Date Time Rbceived 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 /> V <br />