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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_.L� .i/V C,O!I fa[T`//(/r Phone <br /> Address_ <br /> G O • &a r 3791.1` CC to: - - <br /> (1Lr2LoeGle "-A zip ¢ '1 <br /> 1 � <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days, All accounts past due will be subject to inteA�charg 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 /> of �V>> <br /> Con- \ <br /> SAMP ED BY: (si Sure): tan. <br /> J ers n REMARKS <br /> sa pie •' •`' <br /> IPe Sample Location <br /> Date Time Grab comp, <br /> /U1J a <br /> Reli ul0ed by i re): D�t Time Received by(signature): Cat Time <br /> ( K /h 2- Y— <br /> Relinquished b (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 /> Statli Fimsh: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />