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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 t �� i`�� �j C oNs u f� r��/�i Phone '(i <br /> Address h' 0 O X l l t `! CC to: <br /> �? Zip q <br /> Signature of person authorizing workj,� / <br /> under terms stated below' �- <br /> 'Net 30 days. All accounts past due will be subject to interest charges 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 [7//ffz <br /> W a 2 L A Al�� Con- <br /> SAMPLED <br /> °o_ <br /> SAMPLED BY: (signature): tain- <br /> ers REMARKS <br /> sample <br /> type Sample Location <br /> Date Time Grab caro. <br /> 1J14) <br /> Relinq sh by(si ): GDate Tim Regel'ved by(signature): Date Time <br /> rim ;i`4r^G�..d.J `� <br /> Relinquished by(signature): Date Time Re66ived 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): ---=ateTime <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />