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®t� A & L WESTERN LABORATORIES INC. <br /> OFAM1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-1080 <br /> AM <br /> CHAIN OF CUSTODY <br /> Client <br /> C �NEy (�J/V-�LlGT/�/(z Phone r e— 1`f <br /> - <br /> Address c�) .-`- v CC to: <br /> Tt f L OC /t --,4 Zip _— <br /> Signature of person authorizing work " — <br /> under terms stated below' ' <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 ID ANALYSIS <br /> of <br /> Con- <br /> SAMPLED <br /> on-SAMPLED BY: lain- <br /> ,{Si nature): ers <br /> h �` REMARKS <br /> sample <br /> type Sample Location r <br /> Date Time tomo <br /> l /1730 K' <br /> Relinquished by(signtu e): Date Time Received by(signature): Date Time <br /> l` 1� G, '✓ <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 /> Site Time: Driving Time: <br /> Start Finish Total Hours: Start: Finish: Total Hours <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />