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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 /> • ()3 X34 C2-2— <br /> Client ' <br /> z-ZClient ' COnl�tcLTJNL� Phone 0— 6103 <br /> Address • ^3 71-f CC to: <br /> Zip 95 <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest cha es of 1.5% per month. <br /> 'Hazardous materials are the property of the client. The client is'' esponsible for proper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate f$e. <br /> r <br /> PROJECT ID �t r No. ANF�.LYSIS <br /> ARS S of <br /> Com <br /> SAMPLED : (sig erg <br /> ein w C' REMARKS <br /> sample V �') <br /> Date Time type Sample Location <br /> Gnb c <br /> �v Iola X ?( <br /> Tow—iipiv <br /> 3OFr <br /> 4 <br /> Fr <br /> tiu If f s x o �4o t FT' Defiws <br /> cv <br /> y2gf/EL COr�/T�N <br /> R uished net re). t Time Re i ed. y(si n rea <br /> SD t Time <br /> clay 174) 49 L (f)Q t �J� 11',dt� <br /> Relinquished by(signature): Date Time R eived by(signature): bate 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 /> i <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />