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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> -:o-E-.,. n `� <br /> CHAIN OF CUSTODY <br /> ,Q J <br /> Client '`Z N��/ 1'0'�` (f 1 T f PJ!1 Phone <br /> Address f? �X 1' l r�� CC to: <br /> ;'A Zip <br /> Signature of person authorizing'work <br /> under terms stated below' _,o/%- <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 ANALYSIS <br /> o <br /> oly <br /> Con- <br /> SA.MPLED By;#g nature): tain- <br /> ers <br /> REMARKS <br /> sample (n <br /> type Sample Location v <br /> Date Time craG tomo. <br /> Relin wished bytsigrroture): 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 /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> TSite Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish. Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />