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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> nertcurrunnr.eMviaoHMeKru. :o:-::.. <br /> CHAIN OF CUSTODY <br /> Client F u)fV 5 Lz f 7 Phone :,*1- <br /> Address -7 r1 4 CC to: <br /> i 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 /> '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 /> No. <br /> lit i\i < �t� r _ of <br /> SAMPLEp Y: (signa$ Con- <br /> ure): tai - <br /> .// �v <br /> ers y REMARKS <br /> sample' <br /> type Sample Location <br /> Date Time <br /> Grab Comp. <br /> -2 <br /> Relin fished by(si 0i re): Date Time Received by(signature): <br /> j ., 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): <br /> 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 />