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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 " n� Phone <br /> Address ! _�- �9� CC to: <br /> ` et- zip C7` 4; 1 <br /> Signature of person authorizing work <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 ANALYSIS <br /> of <br /> Con. <br /> SAMPLEDBY:,(sig,nature): Iain- c� <br /> ;i ers w REMARKS <br /> 'sample i I— <br /> iype Sample Location <br /> Date Time cac comp. <br /> v <br /> Relinquished by(signatu*: Date Time Received by(signature): Date Time <br /> 'If <br /> Relinquished by(s' ature): J Date I Time Received by(signature): Date' Y4me <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 />