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A & L WESTERN LABORATORIES, INC. <br /> FAI. 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client CL/GSN�I� C'G;yJGrGTiNI, Phone <br /> Address 0' U ' �GX j7 q� <br /> CC to: <br /> UdLpGlr e' /k Zip 1, 1f�Z <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest? arges of 1.50/6 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'No� f ucru<<�t (F ,. TGK gin_ <br /> SAMPLE BY: (signature): tam <br /> REMARKS <br /> sam e I I <br /> o <br /> type SAmple Location <br /> Date Time c„b c P+ <br /> fi 42 ” ( x! <br /> 2-4 ' 1 <br /> n <br /> Reli fished by(sn ): �D�to Time RecEd by(sig ature): Date Time <br /> - //fa /yid <br /> Relinquishedb ignature): Date Time Rece ed 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 /> (V:1 <br />