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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, Califomia 95351 • Phone 209-529-4080 <br /> . <br /> CHAIN OF CUSTODY <br /> Client (�t`I r7 /�I �,^%S�/L T AJ l7 Phone d _ `f<i <br /> Address �' o X CC to: <br /> � L( IhLL)CZip <br /> Signature of person authorizing work ^,i�� L �✓fl <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest cha ges 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 IID / No ANALYSIS <br /> co- / <br /> SAMP D BY: (s e <br /> ature): trs G �,� <br /> rs REMARKS <br /> sample <br /> type Sample Location <br /> 7DateTime Grab Comb ' <br /> Ply <br /> G ' '' <br /> r. <br /> R mquished b vi nature): D t Time Received y signature): ' Daie� Time �e <br /> 12- 1;2 <br /> f <br /> Relinquished by(signature): <br /> Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): <br /> Date Time Received by(signature): Date Time <br /> Relinquished by(signature): <br /> 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 />