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N�4 A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> •GtlNWVN 1MgwEM.4 WSrYIN <br /> CHAIN OF CUSTODY <br /> Client �i �� r�pY �l t d N i Lj Phone 4' <br /> 5� <br /> Address N U 'U CC to: <br /> ,r <br /> 1]�e L.U�� zip <br /> Signature of person authorizing work ip <br /> under terms stated below' %✓r_.: <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 <br /> -T <br /> of <br /> Con- <br /> SAM PLEp BY: (siqa.rjature): twin- <br /> r:. , ers <br /> REMARKS <br /> sample <br /> type Sample Location <br /> Date Time <br /> Grab Comp. <br /> 7z" -- "4 <br /> .i <br /> inquished by si nature): Datil Time Received by(signature): Date Time <br /> Relinquishedby(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 /> 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 />