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s h�� A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> /.CAiNtNMt' ouiHd15�4iNtr�' <br /> CHAIN OF CUSTODY <br /> Client �r�j ?�(��F: �i ��^!7� / '!�U� Phone —>(��l d L? !G�� <br /> Address �' - G r%G' L/! CC to: <br /> fUC 1 0( (.' A zip <br /> Signature of person authorizing wor y✓ <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 /> Con- <br /> SA' ED BY: (signature): to n- <br /> �( �B ers /ry REMARKS <br /> sample <br /> Date Time type Sample Location <br /> Grab Comp. <br /> x +" I x <br /> D.d <br /> In wished by,(signatbre): Date Time Received by(signature): Date Time <br /> Relinquishec'by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Receivedby(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(signature): Date T <br /> ime <br /> Site Time: Driving Time: <br /> Start: Finish: Total Hours: Start: Finish: Total Hours: <br /> Dedicated Exclusively to Providing Quality Analytical Services <br />