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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 <br /> (01Jf Z r)A 4 Phone 101o P,- ♦_J Qui-- . <br /> Address f a nx 37,14 CC to: _ <br /> Ur? LO _k, �^ zip <br /> Signature <br /> -- <br /> Signature of person authorizing work ;d --- <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 /> PROJECT ID No ANALYSIS <br /> N�6Z E!N Sr F'�105 Con- <br /> SAMPLED <br /> o. <br /> SAMPLED BY: (signature): tain• <br /> ers r` IV REMARKS <br /> sample .� <br /> type Sample Location <br /> Date Time GiaD Come <br /> Relinquished by(si ): 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 /> 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 />