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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client Cy E SAl E Y CJA4 L/f L 7/6/l Phone _�62 - 1492— <br /> Address <br /> 1GSZAddress P- B . Box 37e74 Cc to: <br /> 77LZ02 L&) kr 4�4 zip91/ <br /> Signature of person authorizing work <br /> under terms stated below' ' <br /> 'Net 30 days. All accounts past due will be subject to interes harges 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 ANALYSIS <br /> 1O 5tw/ 7'r= _ e. of <br /> Con <br /> SAMPL BY: (sig ): en <br /> REMARKS <br /> Sam01° <br /> tyo° Sample Location <br /> Date Time c,,,,o <br /> H <br /> 7727 <br /> C <br /> Relin Jiahed by( = n ): Date Timeceived by.(signature): ate Time <br /> f ryF/L, .s U z 7 <br /> R inqui ed by signature): D to Time eceived by(signature): Date Time <br /> i <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 />