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A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br />ME= <br />ACRICU.TURAL • ENVIRONIAWAI • MISR. Yf <br />•••••• •••' <br /> <br />CHAIN OF CUSTODY <br />Client <br /> s l'();\ 4-, ; -r/ <br /> <br />Phone <br />Address ;P- <br /> <br />CC to: <br />Zip &:1`1; <br /> <br />Signature of person authorizing work/ <br />under terms stated below* <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 , <br />VIA t <br />No. <br />of <br />Con- <br />tain- <br />ers <br />ANALYSIS <br />' <br />';1_ <br />\s1 REMARKS <br />2 4/:/ji <br />SAMP ED BY4signature): <br />Sample <br />type / <br />/Sample Location <br />Date Time Grab Comp. <br />V.0 V CZ.- I2' / X Y /42-01dHO 12.kr04/e/_) 57, oi Pz.r <br />i <br />R I i hed by (sA'n,ature): <br />/ i.../^ <br />Date <br />/,,),/e / <br />l 7 /1 <br />Time <br />,, ...; <br />( ii- - •i ° <br />Received by (signature): <br />iie//1 pi! <br />x' ii-6/7'2%-( •ii 47.-rilii/lik-a--i- C-i <br />Date <br />/ / <br />, ,, • ; <br />Time <br />Relinquished bY(signature): <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