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A & L WESTERN LABORAAAORIES, INC. <br /> At <br /> U 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client Phone <br /> Address <br /> P- O_ pX 3 7, CC to: <br /> �f1�,2 G.©G1•C, C'A zip s / <br /> Signature of person authorizing work <br /> under terms stated below" <br /> 'Net 30 days. All accounts past due will be subject to interestarges 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 rt, <br /> (2,4 L K/AIS Co- A, <br /> SAMP p BY: (si ure): ers ��t REMARKS <br /> ,v <br /> sample �O <br /> rYPe S mple Location <br /> Date Time Grab comp. <br /> '1172 141j) x F i X. X <br /> Z7R-1 k sFT x <br /> Relinq shed by(s n ): DategTime <br /> eceived by(signature): <br /> Date Time <br /> O7Relinquished by(signature): Dateeceived by(signature): Date Time <br /> Relinquished by(signature): Dateeceived by(signature): Date Time <br /> Relinquished by(signature): <br /> Date Time Received by(signature): Date Time <br /> Relinquished by(signature): <br /> Date Time Received by(signature): Date Time <br /> Site Time: Driving Time: <br /> Start: <br /> Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />