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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. 41 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client C��SN E✓ CDAI Suc77A1/a _- Phone 6611-/403 <br /> Q <br /> Address - O • Ew X 3711 4- ", CC to: <br /> Zip ISL <br /> Signature of person authorizing(work. <br /> under terms stated below' AAhxxx444"' <br /> 'Net 30 days. All accounts past due will be subject to interest c arges of 1.50/1 per month, I <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 IDt ND ANALYSIS <br /> ST 2 Uof <br /> Con- <br /> SAMPLEi <br /> Y: (sig ): %n- <br /> 9�- ers REMARKS <br /> "'M a\ <br /> samle <br /> pSample Location ; \ <br /> Date Time m.e <br /> EX/ o AA LVA 00AIA11 X ECA N bJ TP,e 20/11 <br /> St <br /> Rehn shed b ture): �DMel Time - Re eived by(signat re): Date Time <br /> a� A17" /S17 <br /> Aeimquished'by lsignature) Date Time Received by(signature): t ate 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 /> siteTime: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />