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A & L WESTERN LABORATORIES, INC. <br /> FAI. 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client (fit-1r-- eY ON 'U1 T/ f,11"? Phone __-- <br /> Address r 7 CC to: <br /> T:,I ♦;' f✓ OC,.i7:-, %'�,. zip <br /> Signature of person authorizing work <br /> under terms stated below' Al&' <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 /> !'i!/7i r'k a,A of <br /> Con.. <br /> SAMPLED BY. (si ature): taln. n <br /> X <br /> ers <br /> _.r„ � ,�-v' 4 REMARKS <br /> sample <br /> 'vp° Sample Location <br /> Date Time <br /> ReliRlrdislhed b nature): t Time Received by(sio4t e):Lk <br /> D to Time <br /> /. <br /> Relinquished by(signature): i Date Time Received by(sig ature): 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 /> ( <br />