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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 # Modesto, California 95351 • Phone 209-5294CN30 <br /> CHAIN OF CUSTODY t)!5-231 - <br /> Client <br /> 5-231 -Client �NE� !'DN�4lGT/1VG► Phone `f <br /> Address P o• evx 3 CC to: <br /> 1"12LJ2LA;, C6 __ --ZIp <br /> Signature of parson 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 bg.-aal/4f shat <br /> PROJECT ID No. ANALYSIS <br /> -C7L' of <br /> Con- <br /> SAMPLBY: (si ture): tain- <br /> era REMARKS <br /> Eft <br /> earn le <br /> ryp° Sample Location <br /> Date Time ane COOP. <br /> / WOO X LF X A Fins#1EACN.C1 <br /> X# lov'rw DWJPrH <br /> Or X Lry I X F1E60 <br /> NG/f <br /> — 1 w <br /> Relin s by(si ): ( Date Time Recei e Y signature): Dat f Time <br /> '0Ilf os cc L}l� <br /> Relinquished by rgnature): 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 /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Staff: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Ouality Analytical Services <br />