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A & L WESTERN LABORATORIES, INC. <br /> .A 1311 Woodland Ave. #1 0 Modesto, California 95351 0 Phone 209-529-4060 <br /> CHAIN OF CUSTODY <br /> Client.. <br /> Phone <br /> Address CC to: <br /> Zip <br /> Signature of person authorizing work <br /> under terms stated below* <br /> :Net 30 days, Ail accounts past due will be subject to interest <br /> cha4es of 1.5% per month. <br /> Hazardous materials are the property of the client. The clientis responsible for proper disposal of hazardous wastes. Clients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECTID No. ANALYSIS <br /> Z F--A'A/2-f <br /> of <br /> Com <br /> SAMP/bED BY:.(s nature): tain- X, <br /> REMARKS <br /> sampled 1y <br /> type Sample Location rkt <br /> Date Time Grab 1—ii, <br /> L A.20 <br /> 1i:Cj '—Z <br /> Rel uJished by;�Jo ture): Qate Time Received by{signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Dale 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 />