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' A & L WESTERN LABORATORIES$ INC. <br /> 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client i�E�/Vr�- (1D'V 511 iN h Phone <br /> Address P- -TJX `` 7�r� <br /> CC to: <br /> TiSRLrJcr� r�� zip `�s7 <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 ANALYSIS <br /> '1L{r 2pl<E of <br /> Com <br /> SAMPLED BY: (signature): an <br /> 4 ers <br /> REMARKS <br /> sample V <br /> type Sample Location <br /> Date Time cFm C=D <br /> !/7 C- rE 7,zA .0 T Nk 1A1 7 711 K <br /> Relinq sh d by(sigre): to Time Rec 'ved by(signature): <br /> i r _ _ Date Time <br /> X AA <br /> � � 1255 S< <br /> Relinquished by(signature): Date Time eceived 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: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />