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A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br />D AGRICULTURAL • ENVIRONMENTAL • INDUSTRIAL <br /> <br />CHAIN OF CUSTODY <br />0 e 0 NJ5ut -r/I\J/7 <br />F. 0 -379 4 <br />QLOriv ( <br />/1,/,(<4 <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 />iks/0 <br />No. <br />Con. <br />of <br />BY0 SA ED . ignature): <br />.-eli•/1-a-li <br />tain• <br />ers <br />.i K <br />I <br />REMARKS <br />sample <br />type Sample Location X Date Time Grab Com p. <br />'h ( ,f, 7., v 3 F1: I, / <br />f I . <br />( 12240 >(,. <br />.1" <br />R qiiished by9igiture): <br />i <br />te Time <br />1,() : t)—('-----1-) <br />Received by (signature): 7, <br />/ .0---1 7 ‘--.-- --- I <br />Date , <br />11/47.4 <br />Time <br />/xi,' '.— <br />Relinquishe (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 <br />Signature of person authorizing work 7(1 <br />under terms stated below* <br />Client <br />Address <br />Zip s,36/ <br />Phone - <br />CC to.