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` & L WESTERN LABORATORIES, INC. <br /> 5 <br /> AtL _1:311 .,.Wgodland Ave. #1 • Modesto, California:.9535'i � Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client— � S C'D1�11ULT( Phone:. G 4 D <br /> Address. P. —f CQ.to' <br /> zip <br /> Signature of person authorizing work <br /> under terms stated`belov <br /> Net'30 days: Ail,accountspast due will be subject to interest c6r/es of i.5% per month. <br /> Hazardous. materials are .the propert�,O'f the client. The client is-responsible for proper disposal.ot hazardous vGa$tes.Clients--riot <br /> picking up hazardous wastes may be assessed an appropriate 4e. y. <br /> J <br /> PROJECT ID No, <br /> AN.JL SIS/ <br /> cl�A !Z <br /> Con- <br /> SAM <br /> on ; <br /> SAMP D SY: tore) lain- <br /> ers �((� REMARKS. <br /> sample. I ,V <br /> type Sample Location Q <br /> Date Time Grafi Comp. <br /> 134v 31! <br /> - <br /> Relin sed by s re) at Time Received by(signature)., Date Time <br /> Relinquished by:(signaturo) 'Date- Time Received:by(signature) -.K� Date Time <br /> t <br /> Relinquished�y:(signature) Date Timo Received by(signature) Date:,' Time <br /> s , <br /> Relinquished by.(signature) Date,. Time Received by(signature): Date Time <br /> Relinquished t3.y.:(sigriature) €late Tim$ `Received by(signature):" Date; Time.:. <br /> Site Time Driving Time: <br /> Start: Finish Total Hours: Start: Finish Totai Hours' <br /> Dedreated Exclusiuely to Provi ing,Quaiity Analytical 5e"rvrcesr <br />