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A L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529- 1080 <br /> CHAIN OF CUSTODY <br /> Client C.�J�f a Rey �U��G! L //�/� — Phone 6" 6 .1-1193? <br /> Address % drX ? '� CC to: <br /> zip 2 if 1! <br /> Signature of person authorizing work <br /> under terms stated below` <br /> :Net 30 days. All accounts past due will be subject to interest ch rges 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 /> PROJECTID <br /> / No ANALYSIS <br /> of <br /> Con- 14 <br /> SAMP�LED BY: (syr ture): tin- <br /> ars� / � <br /> � REMARKS <br /> sample <br /> type Sample Location <br /> Date Time Grob comp <br /> C.0 t <�. t X '1/�1�=fir_ �n �� .�.�- /1v.� <br /> CG[ N '6G> <br /> ReIIF'quished b :(sly ature): Dat Time Received by(signature): Date Time <br /> Relinquishe 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 />