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A & L WESTERN LABORATORIES, INC. <br /> FAI.,- 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-1080 <br /> CHAIN OF CUSTODY <br /> Client ce vt,)Sui r/,4j e, Phone <br /> Address 3 a X 3 �9l/ CC to: <br /> T( (? [ VCIC, CA Zip 9539/ <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest 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 ID No. ANALYSIS <br /> �o. <br /> SAMPL BY: ( ' ature): lain- 4� <br /> LaU ers NP � REMARKS <br /> 3smple <br /> lyp0 Sample Location <br /> Date Time <br /> 121 �� � Y ` ��5 WFS T 57� 9 T. /2 X X fA Pr.ED m e 6 owr <br /> Ref u' had by i ure): Data Time Received by(signature): Date Time <br /> ✓ � /,z9 � <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Dale 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 t Time <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />