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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 ()�/ESn/F ✓ �,�fu�.r�Al <br /> -' T---- Phone <br /> Address—� 0 (�i6V �79.� CC to: <br /> 4A zip z l <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest ch 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 /> / L /htn5 0 f <br /> SAMPL BY: (s' Pure): lain <br /> ers V REMARKS <br /> sa le <br /> 1ype ample Location <br /> Date Time Gae cane <br /> Relin i had by(s <br /> r ature): at Time Received.by(signature): Date Time <br /> t <br /> Relinquished b (signature): Date Time Received y(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 />