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�4 A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client r+:`,�' `- ;r » .i ;1, Phone <br /> Address <br /> CC to: <br /> �l -4 Zip �+ <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 /> :Net <br /> 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 /> SAMPLED BY: (signature): tain- <br /> ers ' <br /> REMARKS <br /> sample l <br /> type Sample Location <br /> Date Time <br /> I id I <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> w . <br /> Relinquished by s'ignature): 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 /> 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 />