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A & L WESTERN LABORATORIES, INC. <br /> ` 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> GYVNEN0.4 EIwiYOrv.uEM4 <br /> CHAIN OF CUSTODY <br /> Client Phone /gyp <br /> Address r 'C� �� i i`1 CC to: <br /> i". v't fl I�7 Zip <br /> Signature of person authorizing work /1, <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 ANALYSIS <br /> No. <br /> r'1 {✓(� r i f! w i Cof <br /> on i <br /> SAMPF ED BY:ts' ure): Iain- �2 <br /> u <br /> ers <br /> t, r�r ' REMARKS <br /> sample <br /> type Sample Location �� <br /> Date Time Grao comp. <br /> Imo, <br /> 4! (`�� 1 rte, ✓ ! L i ri, Y` i r i� 'v �� r� l% ( r� <br /> Re' `wished b nature): 4�D)atec Time R, iv'd y(sig at�re�Ln, lDateG Time , <br /> r <br /> Relinquished b`y(signature): l Date Time Received by(siga4iure): 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 />