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A & L WESTERN LABORATORIES, INC. <br /> T. 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client t-` `�� � tf �'!�/V /.�/. �l�Ir Lam_ Phone <br /> Address � 47`� �{ CC to: <br /> `rl r, {Z L b/ 1/ !(, zip i <br /> Signature of person authorizing work <br /> under terms stated below' /Cam Q�iy' <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 No ANALYSIS <br /> / �/� / of <br /> L . <br /> Con- <br /> SAMPLED BY: (signature): tain- <br /> ers y, <br /> REMARKS <br /> s Imp7e t <br /> type Sample Location <br /> Date Time cao ca o <br /> Ir F ,27 tAIA <br /> Refrnquished by(ei,gnature): at Time Received b (signature( � 9 y( 9 ) pat Time <br /> Relinquis` ' 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 />