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A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-40E10 <br /> <br />AGAICUITUR. • (NVIPONNINTAL • INDUST.. <br /> <br />CHAIN OF CUSTODY <br />Client 01-1./)r.. V CON 5 CIL-7/ ,fv4 <br />Address P g bx_ 714 <br /> <br />Phone <br /> <br />CC to. <br /> <br />Zip <br /> <br />Signature of person authorizing work <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 No. <br />tain- <br />ers <br />ANALYSIS <br />4N REMARKS <br />. <br />SAMpXED BY: (sV4ture): <br />sample <br />type Sample Location <br />Date Time Grab Comp. <br />i p ! <br />------:' <br />,., , <br />...„, <br />, ,l a‘h2-10 1 °,4, / / <br />' <br />- <br />I F <br />/ - <br />l 5 , <br />Re)thquished by (s(gn u ). /3 e Time <br />1 1 .'? <br />Rectivedloy (signature): Dat Time <br />/ <br />Relinquished by (signature): Date Time,f--Fre--Ceived by (signature): bate 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