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Phone <br />CC to: <br />A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br />CHAIN OF CUSTODY <br />Client 0 H 1;,'‘2 r-W y routi- A14:7 <br />Address P. b. r, ox 3:7 q-ei <br />-1-1,02,L0 0 ( (1 4-'\ Zip CLI /6/ <br />Signature of person <br />ated below <br />authorizing work <br /> <br />under terms st * <br /> <br />/ <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 />0 14 VrZD (\! - -7-1-1 c RN 7DA/ <br />No. <br />of <br />ANALYSIS <br />/ <br />. <br />i -4-- <br />t,- <br />REMARKS <br />SAMPLp-)BY: (si,9!).:?4ure): fain- <br />Date Time <br />sample <br />typ Sample Location <br />Grab <br />e <br /> Como. <br />1- )//5 4 ,;‘,-, - <br />, <br />7( - 5 2 ‘,..., .. <br />, <br />- Jo ' <br />, / _ i 1 r ., <br />, ^ /;), .;..,1 r), 3 ft; 7 -- Ai v 7 <br />., 7t: -,7" _ W i ,, , <br />P <br />, in uished qy s• nature): <br />./i, c., L.42.4-7.A.x-1:;,, <br />Datft <br />i-r i, I <br />1.,',/,;,.-2. <br />Time <br />;-: /, ) <br /> <br />Received by (signature): ,„ <br /> <br />N•1\ Li. - -)u\-) % \-. i <br />pate <br />25•( 47 <br />Time ,, _.., <br />', • !\..: <br />RelinquisheCiby (signature): ..r bate Time R-g'eived 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: <br />Start: Finish: Total Hours: <br />Driving Time: <br />Start: Finish: Total Hours: <br />Dedicated Exclusively to Providing Quality Analytical Services