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A & L WESTERN LABORATORIES, INC. I <br /> \ 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> clientCO/USG�CT1A1,7 Phone <br /> Address O OX 3 7q4 CC to: <br /> (Z.. l ,Ll Zip 53 <br /> 7 <br /> Signature of person authorizing work <br /> under terms stated below' ' / <br /> 'Net 30 days. All accounts past due will be subject to Interest ch es of 7.5% per month. <br /> 'Hazardous materials are the property of the client. The client is esponsible for proper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate ee. <br /> PROJECT ID ANALYSIS <br /> SAMPLE Y: (si ure): Con- <br /> "a \ <br /> Al <br /> � n� ,,,/��Q� ers /t�,� REMARKS <br /> sample 'yG <br /> Date Time type Sample Location (/ hQ <br /> ..T <br /> 1731-1,230. X w P l X x Sfifr</ v.r Eiq )T /fj' <br /> 7 O S X W-rP36y 36 F <br /> 7-1 <br /> 7', Q6 <br /> 71 l /h0 y �7 X P <br /> 7�J! X XI I I <br /> //11, X ' 7/' k ), 1 1 1 91, <br /> Reli qshed by sure): D tG Time _ .Rece+vedby(signaTu`ri§. ---` Date Time <br /> 7 / <br /> Relinquish y(signature): Date rime---Reoei ignature): Date Time <br /> Relinquished Dy(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 />