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A & L WESTERN LASORATORIES, 'IN , <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 2529-4080 <br /> Wucuuu.IuvnOMMlMN.kWSnLL <br /> 'CHAIN OF CUSTODY <br /> Phone a L <br /> J jAddress_— <br /> X "784 CC to: <br /> _Z 0 C_L' Q zip <br /> r Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest c arges of 1.5% per month. <br /> 1 <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 /> �i <br /> PROJECT ID No ANALYSIS <br /> GF <br /> go I`'IAR1�11� con <br /> SAMPL BY: (si ture): tain <br /> ers REMARKS <br /> sample •E <br /> type Sample Location <br /> Date Time Grab Como. <br /> y X LL SA Mf' rzo F 56 7' <br /> F��GU �xrSTi� G�CfILiNE <br /> E Q �� x �✓ F 7Ic <br /> S P .E 2. G - <br /> aF–La`J G <br /> s <br /> r <br /> P <br /> k <br /> at Time Rec 'ved by(signature): Date Time <br /> Relin i had by re): 1 <br /> ?7 <br /> 3SSze - <br /> Relinquished b (signature): Date Time Re ived by(signature): Date Time <br /> Relinquished by(signature): <br /> Date Time Received by(signature): Date Time <br /> jDate Time Received by(signature): Date Time <br /> 1 Relinquished by(signature): l <br /> I <br /> Relinquished 6y(signature): <br /> i Date Time Received by(signature): Date Time <br /> h <br /> { Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> I <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />