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' A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> f Client L'N 55AIf ('ON.(V Z-7-ItJ 4; Phone <br /> Address 0 oK 3 7 q� CC to: <br /> �Tu rZ 4 oc!/- Zip qS? 0 f <br /> Signature of person authorizing work <br /> I under terms stated below" <br /> 'Net 30 days. Alf 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 /> IN -5T(C l,/ G Lof <br /> Con• <br /> SAMPL BY:=(Siure): teis �w �� <br /> REMARKS <br /> sa ple <br /> Date Time Gm, <br /> b lc ample Location <br /> a�c. <br /> 143o �, I Ife4q IV• fAc k TaNE.2r7. }( S/� �tPcFn FRor•-! /-/OIjs 51,0 <br /> E //ousfr AZ:re.4 <br /> fQ q ,4;, x J J9g34,? ,A1- -7-Ark rvuF 3 a �x Pcr� <br /> E <br /> Reli shed b ature): D to Time Re 7'd by(signature): Date Time <br /> /Q &�a� 1_Lw <br /> Reiinquishe by(signature): Date Time Re ived by(signature): ;r Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> y{(signature):b <br /> Relinquished nature): Date Time Received by(signature): Date Time <br /> q g <br /> Relinquished by(signature): Date Time Received by(signatu(e): Date Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />