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A & L WESTERN LABORATORIES, INC. <br /> T. 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> AGI-!W•FN"YIPGK4£MAI iNDUSiAW <br /> CHAIN OF CUSTODY <br /> Client / /4 /✓,,--'l C�T� Phone 4,�;'2 /cs "_� <br /> Address �`~ Q �� �'�`�- <br /> CC to: <br /> Tl /�1' /In'> zip <br /> Signature of person authorizing work <br /> under terms stated below* zt <br /> L> <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 / No ANALYSIS 4 <br /> of <br /> n. <br /> SAM PLEDv BY: (si�i7yre): a�n- R \ <br /> ers A� REMARKS <br /> sample <br /> type Sample Location �Q <br /> Date ;Time Grab comp. <br /> FTTk r� <br /> Reli ud by I 10ure): Date Time Received by(signature): Date Time <br /> Relinquished b signature): Date Time Received by(signature): _ Date Time <br /> Relinquished by(signature): Date Time Received by(signature): �#me <br /> ime <br /> Relinquished by(signature): Date Time Received by(signature): ime <br /> Relinquished by(signature): Date Time Received by(signature): <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />