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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, Calsffamia 95351 • Phone 209-529-4080 <br /> .WlK4TIW lM4LYMtIMN MGpItlAL <br /> CHAIN OF CUSTODY <br /> Client _ t, hi lJll��i� C0A ,5Vt7_/1V( Phone <br /> Address P- D aOX 1714 CC to: <br /> 7U I OUB, lA zip 05381 <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest c)karges of 1.5% per month. <br /> *Hazardous materials are the property of the client. The client is responsible foI roper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECT ID No ANALYSIS/ P111 <br /> r>']E L D rAIDV 51 R 4 1 PAF co- <br /> SAMPLE ' Y: (si t rt3): lain- ` �� <br /> ers �G P REMARKS <br /> sample <br /> 'Ype Sample Location <br /> Date Time ialas 1comp. P� a <br /> l�fa Y r,JV1205E("ViR 'EF•FLuf1V �Z <br /> Relin i hed by re): Wat Time Re ei ed y(signture): / Dite Time <br /> Relinquished b signature): bate Time R eived 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 />