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y <br /> W <br /> A & L WESTERN LASORATORI <br /> AtA <br /> ES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client i! <br /> 7 � <br /> Phone Ir76 G=- ;.0 r' - <br /> I Address <br /> f• uE �C, '��, <br /> CC to: <br /> I` Zip -1.:.� `�j <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interestcharges of 1.51/a 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 ANALYSIS <br /> r.. <br /> No, <br /> of <br /> LSAMPLED BY: (sigrtature): °n- v <br /> sample ,ti, ��- <br /> REMARKS <br /> type Sample Location �? <br /> Date Time <br /> Grafi Camp. <br /> l y� ! V F �✓ 1. 1C lti f <br /> ei <br /> a(V Af .J'r4 L L —, a)V r c' �f <br /> i <br /> Relinq Ps",hed by(sjg tyre): ]ate Time Received by(signature): <br /> f fq Date Time <br /> Relinquished by(signature): f Date Time Received by(signature <br /> Date Time <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Date le <br /> ; <br /> Relinquished by(signature): Date Time Received by(signature): . <br /> Date Time <br /> k <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Date Time I <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: <br /> Finish: Tota)Hours: <br /> Dedicated Exclusively to PPoviding Quality Analytical Services <br />