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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> �GtlMl11Ml 1IMOYIIRM M61W <br /> CHAIN OF CUSTODY <br /> Client ( 0A21 al T/N6 Phone <br /> Address P © • �X. 3714 _—___- CC to: __- <br /> "" 9s� f <br /> (Z L i" <br /> Signature of person authorizing work <br /> under terms stated below' �•��',. 1r w f Q. yt<y <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 ANALYSISof <br /> Con- <br /> SAMPLED/BY: <br /> omSAMPLED`BY: (Signa e): tarn <br /> ers REMARKS <br /> sample <br /> type Sample Location `a <br /> Date Time �„b tomo. <br /> Re li q Ished by ature): patq Time Received by(signature): Date Time <br /> Relinquishe by(signature): Date Time Received by(signature): )OaEe 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 />