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A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br />CHAIN OF CUSTODY <br />1.(1„.4; M CONV,Iii) NO <br />Address :9-17.01(s (-) <br />Client Phone <br />CC to: <br />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 4arges 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 1 , <br />i--/-, D. . P No. <br />of <br />ANALYSIS 7 <br />- <br />V ' REMARKS /j1.- , <br />1,1 <br /> <br />SA D BY: i <br /> <br />i ••.1 ,, <br />ture): <br />"/ / hi2-7 <br />Con <br />tain- <br />ers <br />Date Time <br />s pie <br />type / Sample Location <br />G ,ab con„ <br />12-11-7i al ; lj V:...,- '4r-- / X <br /> 74 r K / i.,-/ -,' I )< :,/,' x <br />2. WOO ,x,. I 5- 47 I' -..)", x X- <br />/ <br />(‘i X—) <br />Relinq stied by (sLicb,a,t/): <br />. /1/6414 <br />Date Time <br />1 1 <br />. <br />1 i <br />42 <br />Rece,jved by (signature): <br />, .') <br />7 ___-._ _, -; J , <br />2 <br />Date <br />: 7:). 3 <br />Time <br />ii•r-Q. <br />Time <br />--- <br /> <br />Relinquished by ignature): bate Time <br />}' <br />Received by (signature): Date <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