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y t" A & L WESTERN LABORATORIES INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 0 Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client__l�l�-����(,� Phone <br /> Address R,Q x <br /> t CC to: <br /> l —zip <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest charg sof 1.5% per month. <br /> :Net <br /> 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 /> IVA- V14 �/1 it rY1� of �, <br /> o <br /> SAMPLED BY:J9i nature): a�� �\ <br /> /i1Qt� ers REMARKS <br /> ample <br /> Date Time type ample Location <br /> Grab lComp.1 <br /> \� <br /> / <br /> R n ished ature): D t Time Re i.ed b <br /> � �y y(signa1�ure): y Date Time <br /> �ILTf1t .1n/ �;7) <br /> Relinquish d y(signature): Date Time Received b si nat re: f <br /> Y( 9 ) Date Time <br /> Relinquished by(signature): Date Time Received b (signature):Y( 9 ) Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> i <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> i <br /> Site Time: Driving Time: i <br /> Start: Finish: Total Hours: Start: v <br /> Finish: Total Hours: <br /> I <br /> Dedicated Exclusively to Providing Quality Analytical Services j <br /> i <br />