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%. A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client. Phone 6 e. <br /> Address OOy x % d CC to: <br /> 't`t,.r,Z L._ DL.y- ,"A - - zip ? / <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest ch rges 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 No ANALYSIS <br /> con <br /> SAMPLEDIY: (sign r ): fain- �4 <br /> ers REMARKS <br /> sample <br /> type Sample Location <br /> Date Time Grab coold <br /> d x <br /> G � <br /> Reli uished by(si ure): �te Time Recrived by(signatureh: Date Time <br /> r, t <br /> Relinquished y(signature): Date Time 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: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />