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A & L WESTERN LABORATORIESs INC. <br /> OL 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client uM Nva Phone 4O t(a -- <br /> Address 0 pX — 724 CC to: <br /> TSV P <i zip 3431 <br /> Signature of person authorizing work <br /> under terms stated below- k , <br /> 'Net 30 days. All accounts past due will be subject to interest c arges 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 I*C�p No ANALYSIS <br /> L of <br /> Con- <br /> SAM PL ): Iain- rt_/ REMARKS <br /> Sample LocationDate Time <br /> G' oo r a X A)rz 9 FEE Ir <br /> �o S e1 / Ai0,^l-DA f I~V So/G r <br /> Relinq sed by( ' re): 1Patq Tim R/ecc ad by(siggasture'):: / Data Time <br /> Relinquished (signature): Date Time Re8elved 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 /> Staff: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />