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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> 3k <br /> CHAIN OF CUSTODY 1 <br /> Client. tll JNM I/Al <br /> �7 q Phone <br /> Address �. 0 6 Y S / nI 4 CC to: <br /> RL0"/r <br /> Signature of person authorizing work <br /> under terms stated below' .c/ <br /> 'Net 30 days. All accounts past due will be subject to mteres 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 /> PROD T ID o. ANALYSIS <br /> INk N <br /> of <br /> Con- � <br /> SAM ED 131 r9signature): Iain <br /> /`/�,Y/ ers <br /> A O r . REMARKS <br /> sample <br /> Date Time type Sample Location <br /> Grab CanO <br /> 211 //Of x I I N2l / d z5 13,,5 Ar KX 'Gc . <br /> Relin stied by(s ure): /ppat Time Received by(signature j ,gate Time <br /> h /zf�9 l23o fr, ,�.� y ,t ; jZo <br /> Relingwshed by signature): Date Time eceiv6d 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 />