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A & L WESTERN LABORATORIES, INC. <br />M 1311 Woodland Ave. # 1 • Modesto, California 95351 • Phone 209-529-4080 <br />♦GtlCln . emwwrwru . e .. <br />CHAIN OF CUSTODY <br />ClientN �Jl%G �Dl�i�7 rf l Al 7z Phone c2o 4 : - <br />Address `� o �� x- CC to: <br />I <br />Signature of person authorizing work <br />under terms stated below' 4)'%^ <br />'Net 30 days. All accounts past due will be subject to interes 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 <br />NO <br />°' <br />Con- <br />taln <br />ers <br />ANALYSIS <br />REMARKS <br />SAMP ED BY: 0J nature): <br />sample <br />type Sample Location <br />Date Time Grab tomo. <br />Reli gpished by sig ture): <br />D to <br />Time <br />Received by (signature): <br />Date <br />[Ti 2me <br />Relinquishe (signature): <br />Dae <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Site Time: <br />Start: Finish: Total Hours: <br />Driving Time: <br />Start: Finish: <br />Total Hours: <br />Dedicated Exclusively to Providing Quality Analytical Services <br />