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A & L WESTERN LABORATORIES, INC. <br /> 64 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Clientaz Tin/! <br /> ��4 <br /> Phone <br /> Address_ P• o , ox <br /> CC to: <br /> 1-1"/Z/- 04SA Zip 3g/ <br /> Signature of person authorizing work <br /> under terms stated below' <br /> �L " <br /> 'Net 30 days. All accounts past due will be subject to Interest he es of 7.5% 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 ANALYSIS <br /> LA s Poi 1-n1j s of <br /> SAMPL BY: (si Con <br /> ure): tare. <br /> REMARKS <br /> samCle ) V <br /> Date Time type Sample Location L7 <br /> one co-.n. <br /> la zao u F X SArr)ln(= TAkEN Un/DFR <br /> r/N cA C,61Flo-, <br /> Relin i edby s e): D to Tim Re e0{wby(sign lure): Date Time <br /> / Yl <br /> Relinquished D (signature): Date Time Re 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(stgnature): 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 />