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A & L WESTERN LABORATORIES, INC. <br /> l <br /> AIL. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 J <br /> CHAIN OF CUSTODY <br /> N <br /> Client Phone <br /> Address <br /> (! �/C 7 CC to: - <br /> Zip S <br /> Signature of person authorizing work <br /> under terms stated below" <br /> 'Net 30 days. All accounts past due will be subject to interest char s of 1.50/O per month. <br /> 'Hazardous materials are the property of the client. The client is r sponsible for proper disposal of hazardous wastes. Ciients not <br /> picking up hazardous wastes may be assessed an appropriate fee. <br /> PROJECTID <br /> No ANALYSIS <br /> of <br /> Con- <br /> SAMP D BY: ture): taro• <br /> ers REMARKS <br /> sample , <br /> type Sample Location <br /> Date Time Grab COmp <br /> r <br /> Relin u ed by to <br /> at Time R ive by(signature): Date+ Time <br /> �r.w., <br /> i b (s <br /> Tie R ceive <br /> time.e <br /> i na uredby(slgnature)` <br /> Reliqshed Date Time <br /> Date Time Received by(sig nature): <br /> elinquished by(signature): <br /> Relinquished by(s.ignature.):.. <br /> Date". Time Received by(signatu(e): Date Time <br /> Relinquis <br /> heCi by(sigheture) <br /> Date + 7lme Received by(signatire) Date. Time " <br /> Site Trme Driving Time <br /> � Start ti~ihish TotaLHours. <br /> Start: <br /> 'Finish. Total'Hours: <br /> F Ded,ca#ea ,cxc7us+trely`. fo Provrdrng Qualdy Rnalytrcal Services <br />