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A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br />, AGIKUITURAL • ENVIRO.ENTAL • INDUSTRIAL <br />mreamaga <br /> <br />CHAIN OF CUSTODY <br />Client <br /> <br />i v C 0 Ni51) if/ iN/ (7 <br />P-6 37 C)4 <br /> <br />Phone <br /> <br />Address <br /> <br />CC to: <br /> <br />Signature of person authorizing work <br />under terms stated below • A A7A r OtH,e,t/ <br />' 1...i' <br />*Net 30 days. All accounts past due will be subject to interest charges 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 7 <br />(7 P, L:; tvA L <br />No. <br />of <br />Con- <br />ers <br />ANALYSIS . <br />, i REMARKS b 1„ <br />. <br />1\ <br />SAMKED <br />/ <br />(......i-)- <br />BY: (akomature): <br />1 ,.t.--'' , <br />/A /Ad...ft.-el <br />sample type Sample Location Date Time Grab COMP. <br />FF. <br /> 41/ / <br />„ ,,-- , Relinotiished by (sig. nfaytpre): pate <br />CI Li <br />i --' (-) <br />I <br />i 1 <br />Time <br />, <br />/v <br />Rece ir i ed by (signatp): ./ <br />; ./ k Date Time <br />Relinquished by (sgnature): I <br />/ <br />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: <br />Start: Finish: Total Hours: <br />Driving Time: <br />Start: Finish: Total Hours: <br />Dedicated Exclusively to Providing Quality Analytical Services