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Client <br />Address <br />5 1. 1 / \ <br />Zip <br />Phone Oj a>j <br />CC to: 0 c 7(4 <br />A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-44380 <br /> <br />CHAIN OF CUSTODY <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 properly 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 />No <br />of <br />Con- <br />tain- <br />era <br />PROJECT ID <br />0 iq <br /> <br />SAMPLE,D7 Y: (si t g\n ,J4re): <br />/7v-eli sample'. <br /> <br />type Sample Location <br />Comp <br />Date Time <br />Grab <br />REMARKS <br />T Relin .ished by (siOaure):,. <br />' Jr 1-7(Aiii/ l 'iA I <br />/ <br />Relinquished by (signature): <br />Relinqu'ls6ed by (s4dn'ature-): <br />Date Time Received by (signature): Date Time <br />Date Time Received by (signature): Date Time <br />Date Time Received by (signature): Date Time <br />Relinquished by (signature): Date Time Received by (signature): Date Time <br />Relinquished by (signature): <br />Date Time <br />Finish: <br />Site Time: <br />Start: Total Hours: <br />Driving Time: <br />Start: Finish: Total Hours: <br />Date Time Received by (signature): <br />Dedicated Exclusively to Providing Quality Analytical Services