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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-1080 <br /> CHAIN OF CUSTODY <br /> Client (7Fii sr�J•�r— `� ��',�(<,; {� T!!\+r �_ <br /> Phone -2 (22 407 - /vim �- <br /> Address 04 `�` CC to: <br /> �{! ( Y fir, Zips , <br /> Signature of person authorizing work/( o /y <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 /> PROJECTID No ANALYSIS <br /> of <br /> F �i�i L Con- <br /> SAMP ' D BY: �aignature): tain- z <br /> ers h� REMARKS <br /> ; <br /> ample <br /> type !Sample Location ., <br /> Date Time Grab Ir-11. <br /> Rel ui hed by(sjCn ture): Date Time Received by(signature): Date Time <br /> PI <br /> Relinquished b. (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(sig nature): 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 />