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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 /> Client , CO/+�l UG T/�✓C Phone <br /> Address 0,` 3 7 1 " CC to: S <br /> �Lf R LGlc zip <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 3o days. All accounts past due will be subject to interest c rges 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 ANALYSIS <br /> OCLIA ZPAIR °f Con- <br /> SAMP D e(SI . fain- <br /> ers a REMARKS7 <br /> Samp a Location <br /> Date Time Iter01d ESL <br /> (S D IntELL <br /> Itro K Alb K W,51-L 1 IX <br /> *shed *gnia <br /> ate Time eived by(signature): Date Time <br /> 145 <br /> Date .Time ceived"by(signature): <br /> Date. Tame"' <br /> Relinquished,by`(signature) Date Time Received by(signature) Date Time. <br /> Reliriquished by,(signature) Date Tame Received by(signature). Date Time. <br /> "Relinquished by(signature} <br /> Date Time Received by(signature). Date Time <br /> 5ite'Time Dnv.ing Time: <br /> Sfart:. . Finish:. Total Hours Start'. Finish Total Hours:' <br /> Dedi.ca,ted Exclusively to .Providing Quality Analytical Services <br />