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A & L WESTERN LABORATORIES, INC. <br /> T. 1311 Woodland Ave. #1. 9 Modesto, California 95351 • Phone 209-529,4080 <br /> CHAIN OF CUSTODY <br /> Client C' �`� )/� {/ �1��'✓ /�� Tf/��� Phone <br /> Address CC to: <br /> Zip <br /> Signature of person authorizing work <br /> under terms stated below' %z., ! <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 A No ANALYSIS <br /> 5�!<1,41 of <br /> Con. <br /> �((� <br /> SAMP-'�D BY: ' ature): ers G <br /> REMARKS <br /> sample <br /> type Sample Location <br /> Date Time Grab can,. <br /> r 7-- <br /> f <br /> rrs;, >< GThiP x x 5A Ir r zpy✓J �i/ n %A �/ <br /> i <br /> '7-R <br /> -r- A. 4 a/vi <br /> t i'r'k ` V ! <br /> Relin#sed by(si �i 0): Date, Time Received by(signature): Date Time <br /> Relinquished by(signature): Date Time Received by(sigf ature): 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 />