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^fir <br />LNRORATORIES <br />A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 * Modesto, California 95351 • Phone 209-529.4080 <br />CHAIN OF CUSTODY <br />Client M f J /try y 1 '0AI U 1. Tw Phone ">?a`'% —407 -16 5 C <br />r; <br />Address i•`p X F,7at-4 CC to: <br />zip <br />y, <br />Signature of person authorizing work <br />under terms stated below'/'Ufl <br />'Net 30 days. All accounts past due will be subject to intelt?st 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 />G,i J.i 1"Ic V /yi,f N0r /"//-/o <br />No ANALYSIS <br />Con- <br />fain- <br />ers <br />t1� <br />REMARKS <br />SA I_ED'BY (signature): <br />sample <br />type Sample Location <br />Date Time Grab Como. <br />i,. <br />Relinquished by ( g ure): <br />1 <br />kl <br />gatq <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): �l <br />Date <br />Time <br />6eceived by_.(signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Site Time: <br />Start: Finish: Total Hours: <br />Driving Time: <br />Start: Finish: <br />Total Hours: <br />Dedicated Exclusively to Providing Quality Analytical Services <br />