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A & L WESTERN LABORATORIES, INC. <br /> o <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 0 Phane 204529-4080 <br /> CHAIN OF CUSTODY <br /> ; <br /> Client /V Z 7 Phone <br /> Address CC to: <br /> . Zip <br /> Signature of person authorizing work i <br /> under terms stated below* <br /> *Nei 30 days, All accounts past due will be subject to interest ch/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 la No. ANALYSIS <br /> of <br /> Con- <br /> SAM PLE P'BY: (sigpature): tain- <br /> ers <br /> REMARKS <br /> a,"ple <br /> Date Time type <br /> Sample Location <br /> Glob C "P- <br /> Relintjujshed by(signature): Oat? Time Received by(signature): Date Time <br /> Relli14-u-Ished by'(signature): Date Time Received by(signature). Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> I I <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 />