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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 < leCGAI <br /> nn � Phone �✓2-" 1G,7� <br /> Addressr-_ •o oy <br /> y <br /> Zip CC to: <br /> }�' � <br /> Signature of person authorizing work ' 1 � <br /> under terms stated below' r ( - <br /> 'Net 30 days. All accounts past due will be subject to interest arges 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 /> 04VE {y 1 N),;) No. <br /> Con- <br /> SA ED BY' jgnature): tain. ,✓. <br /> ers <br /> v �." C� REMARKS <br /> sample �' <br /> type Sample Location ^. <br /> Date Time ,.� <br /> Grab caro. <br /> it <br /> Rel uishe ,y, ignature): Dat Time Received by(Signature): <br /> g Date Time <br /> nyt7 <br /> Relinquished by( ignature), Date Time Received by(signature): <br /> Date Time <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Date Time <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Date Time <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Date Time <br /> Site Time: <br /> Driving Time: <br /> Start: Finish: Total Hours: Stan: <br /> Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />