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A & L WESTERN LABORATORIES, INC. <br /> M 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> �9 <br /> Client <br /> Phone <br /> Address U L�o X 1 1 CC to: <br /> ( L/I•C L 1% C A Zip ir�! <br /> Signature of person authorizing work ���� <br /> under terms stated below` .17/.����f—tom ' <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 /1 No ANALYSIS \� <br /> i---r,4 (11iA �.� � of \ <br /> SAMPLED BY: (signature): ain• +� <br /> ers REMARKS <br /> sample � ! � <br /> Date Time type Sample Location C \ <br /> Grab Comp. <br /> 7 X E r7>` r 4 ;k/W <br /> Re 'q `fished byi nn ture): at Time Received by(signature): Date Time <br /> /r"'7 ,m_ 1 L. �„ n <br /> y � y <br /> Re inquished 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 />