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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-5234080 <br /> ,�.f - , /f ♦ CHAIN. OF CUSTODY <br /> Client�_;� tvF G'� '.'1j Phone <br /> Addre cc to: <br /> rA 71. 9S <br /> Signature of person authorizing work �G1gJ�t�— <br /> under terms stated below' — <br /> 'Net 30 days. All accounts past due will be subject to interest chi 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 no! <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECTIDA <br /> y GU r No ANALYSIS <br /> tiv <br /> Con �4 t0 �Qt <br /> SAMPL BY: (si re): faun <br /> ers REMARKS <br /> MnSample Location ` <br /> Date Time enc cans- /\ <br /> 11 /100 X 1 W d( L F r X y etawllAtOw/A7xr Nor Ttf i'F. <br /> (.EAC<+Fy eo <br /> /I//& moo X 0 n/ /-A k,5 l X <br /> li iSly x e o nt D-Flee' G_ e 1 X <br /> i <br /> I <br /> Felity u hed by 1 re): �D/ate JTime <br /> ecelved by(signature) - Date Time <br /> Relinquished b (signature): Date eceived by(signature): Date Tnne <br /> Relinquished by(signature): bate eceived by(signature): Date Time <br /> Relinquishedby(signature): Date - Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Tirne Received by(signature): Date Times <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Stan: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />