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A & L WESTERN LABORATORIES, INC. <br /> Ilk,M 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-1080 <br /> �T <br /> -CULT—•ENY140WE-L•i­STRIA; <br /> CHAIN OF CUSTODY <br /> Client 6f j-t j�( !� �O ry�((! T li��/� <br /> Phone ���I - 'il� 1 - / 2 <br /> Address >✓- (J (� X �>?`�LJ CC to: <br /> ( l k % 0( k `Q zip <br /> Signature of person authorizing work �� <br /> under terms stated below' <br /> l <br /> Z 11 <br /> .Net 30 days. All accounts past duewill 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 No. ANALYSIS <br /> "E AJ C0//1 of <br /> Con- <br /> SAMP�A,D BY: ( nature): Cain- << <br /> ers �tvi ` REMARKS <br /> sample <br /> type Sample Location <br /> Date Time <br /> Grab Comp. <br /> 3 x' ' Z 17 FE <br /> Z T <br /> Rel n, ished by25 /1 <br /> ture): Date Time Reyeived by(signature): Date Time <br /> / � '2 l /i <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 />