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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 9 Modesto, Califomia 95351 e Phone 209-529-4080 <br /> Al <br /> GPICIIWW <br /> EN-0-.IN—— <br /> CHAIN OF CUSTODY <br /> Client < fl_ Phone <br /> Address CC to: <br /> L 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 /> of <br /> Con- <br /> SAMPI-w�D BY: (signature): tain- <br /> ers <br /> REMARKS <br /> ample A* <br /> type Sample Location i4 <br /> Date Time Grab C"P. <br /> Relinpluished by'Isigq6ture): Dqte Time Received by(signature): Date Time <br /> o <br /> Re I i nq u 1 shed'by'(signature): Date Time deceived 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): 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 />