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' A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 o Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client iry(ISN E � y+/lu�i/Nff, Phone <br /> Address- 7-r4- CC to: <br /> �UR t-of V C'�1 Zip 5 yrs' <br /> Signature of person authorizing work <br /> under terms stated below' -Ig <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 /> /,9L L l� <br /> Cof on. <br /> SA P ED ture): tain• <br /> ers �L <br /> REMARKS <br /> sample <br /> type <br /> Date Time Sample Location (/ <br /> Graf Comp. <br /> i' <br /> t � <br /> t <br /> Reli ui hed by(sin re): ate Time Reeeived by(signatu e): <br /> f Date Time <br /> Relinquished b ignature): <br /> ate Time Req'eived by(signat�e): Date Time <br /> Relinquished by(signature): Date Time Received b g ) Date Time <br /> y(si nature <br /> Relinquished by(signature): Date Time Received by(signature): <br /> I Date Time <br /> Relinquished by(signature): Date Time Received by(signature): <br /> ffp <br /> me <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: <br /> GFinish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br /> ,. <br /> 4 <br />