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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 a Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client Phone GG0- ��U3 <br /> Address f- U UOX 3-79 CC to: <br /> 7U/2 Z /C zip 9S7Y/ <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest Arges 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 No ANALYSIS <br /> Piz/CJS %� of <br /> Con. <br /> SAMPLED,J: (Sign u ): lain. \ <br /> ers nr�J.Q' REMARKS <br /> sam0le ��- <br /> typii <br /> 1_ Sample Location <br /> Date Time ".iitomo. <br /> JJ J1 /i'ud Y 2-411 -<4 r'!_fD '/2d/rl i?G"'7c; <br /> 3oizrn!i- <br /> i 3r o /Jot X 'r <br /> Re lin ui ed byli lure): Dspa Time Re ed y(sign„f lige) D to Time <br /> 3 or 1J`{s c <br /> Relinquished Ey(signature): Date Time Re eived 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: Sta t: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />