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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 r .t GC L T/A/G, Phone 3 <br /> AddressX2113 I � O k -37q¢ CC to: <br /> -Lf 2GL0 r 4G4 GA zip / <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. Ali accounts past due will be subject to Interest cha ges 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 Na C <br /> xlyt;11111 <br /> of <br /> Con. <br /> SAMX7V: ' ature): Iain- <br /> ers <br /> REMARKS <br /> smple <br /> type Sample Location <br /> Date Time G,, C.P <br /> !Z 0 / x / 2D 3 X 5A/riPLE Ajfi rRIF dE D <br /> S err F[e. k�i <br /> 'Z 4,1 x 8 A E Y <br /> ry0 Ly b 8 C P <br /> Reli ished byure):Da Time Received by(signature): Date Time <br /> Relinquish y(signature): Date Time Re eived by(signature): Data Time <br /> Refinquished 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 Flours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />