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Client Phone ) -42 - <br />CC to: <br />y f <br />Address /3 ' 6 .5 /3/ -377-1 <br />A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-5294080 <br />CHAIN OF CUSTODY <br />f Zip 9 S-3/ <br /> <br />Signature of person authorizing worV 1- <br />under terms stated below • I. , <br />*Net 30 days. All accounts past due will be subject to interest char 's 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 <br />,i< /4'4 ; ; // A: — 4.--- of <br />Con- <br />ANALYSIS <br />I. <br />/\ REMARKS <br /> <br />/\ <br />f' SAMP,LED BY: (7ure): <br />4 <br />sample <br />type <br />/, <br />Sample Location <br />Date Time Grab Comp, <br />—2 4- i-- ). <br />4 /q3 ' _ x <br />, <br />/.., <br />Re7kjui hed by (sign re): L../...9u 9eate/ Time <br />./:; Z ej, <br />.._,Receiv—e-d'py (signatu e):_ <br />---..' >1----7 ,--<' _....--; `----1.---- <br />D# te 1 <br />i/ <br />Time <br />j <br />i '1 I.) <br />Relinquished by (signature):Date ,-' Time Reived 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