|
A & L WESTERN LABORATORIES, INC.
<br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080
<br />CHAIN OF CUSTODY
<br />C.2Z -/&_,L;7137,-
<br />Address P. C' )(:)v 7)7.14
<br />
<br />CC to:
<br />
<br />RI tr,)0(-, A
<br />
<br />7 (I
<br />Zip
<br />
<br />Signature of person authorizing work
<br />under terms stated below•
<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
<br />/ VU ri/ giiri''M d'
<br />No.
<br />of
<br />Con-
<br />tain-
<br />ers
<br />ANALYSIS
<br />, '4'7 1 v.
<br />C/ • REMARKS
<br />SAMRrtEp BY: "friffu,fe):
<br />14/;...41 , , C-P.,..:4-1-1.--'Q
<br />sample type Sample Location Date Time Crab Comp.
<br />‘''4 9rC•;,0 72— 6 /-- F / x... ,/ ,..,_ A Ci--i ,,== / 0 ( ,477- /
<br />.- .
<br />i 7, i T...1.-,zor 0 F. z i) 77
<br />' o,Q)cc r -- 6 1 i L.. ):,X (1 (?,c, F 24...4 Ai P ,
<br />.
<br />, .--, ),- , ,-ir),°7 3 /2 47.21., i'.., / -,,z... ,,,, /4 ,72_6 Pill _
<br />k,..
<br />/
<br />' quished b nature): Doti Time
<br />f
<br />1 Rectvkd atfrire)ti.i
<br />-- -- i ,., u-tirite./ ,f•-'
<br />.,_Date _
<br />-,:" _,..,-/ I i
<br />Time
<br />i t -
<br />Relinquished by (signature): t Date Time Received by (sigoature): 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:
<br />Start: Finish: Total Hours:
<br />Driving Time:
<br />Start: Finish: Total Hours:
<br />Dedicated Exclusively to Providing Quality Analytical Services
<br />Client
<br />
<br />Phone
<br />
|