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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 /> / Phone C- � - �(�� •G ��? <br /> Address r 1) 7 r( <br /> / CC to: <br /> Zip f 'Y; <br /> Signature of person authorizing work %„ l ,• kyr ' <br /> under terms stated below' <br /> ,r <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 /> ofCon- ! <br /> SAf�PLED BYi gnature): tain- <br /> ers <br /> REMARKS <br /> sample <br /> Date Time type Sample Location F <br /> Grab Comp. <br /> Rel 'quished by(signature): Date Time Received by(signature): ate 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 /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish. Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />