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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-52 80 <br /> acticunw.e+naawnnu..mn}ru - <br /> CHAIN OF CUSTODY <br /> Client AlU L <br /> y7 Phone �� - 140? <br /> i Address L• G • F,0 )c E724 CC to: <br /> �{[ R L-OC.V Zip 11;31 <br /> Signature of person authorizing work <br /> under terms stated below• ��/LLL���/LL��� �4" <br /> 'Net 30 days. All 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 IDNa ANALYSIS <br /> MA AIA of <br /> Con- <br /> SAMPLEP J,BY: (si re): tain- lyJ <br /> ers `F <br /> REMARKS <br /> sample <br /> Date Time type Sample Location �p <br /> Gran coma. <br /> S3 x <br /> 47- <br /> sample z X >( <br /> f 3a I54v x /2 <br /> j S 3 v /SSs Z X X <br /> J <br /> Reli u' hed by e): 4at Time 7cej . d b (signature):�Y f 9 Date Time <br /> II1 i <br /> l <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 /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> i Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />