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10 4, <br /> j A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, Califomia 95351 a Phone 209-529-4080 <br /> CHAIN OF CUSTODY <br /> Client U Phone 41,."3_ 1403_ <br /> Address CC to: <br /> 14_ (4A Zip - I <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest c arges 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 ED ANAL <br /> N o. <br /> / A °' <br /> Con- <br /> Y/SAMP BY: (si ture): twin- <br /> ZAk ers REMARKS <br /> sample <br /> type Sample Location <br /> Date Time crap comp <br /> -7 7 �. <br /> i <br /> Relin ' d by(signs r tt Time Rece'ved oy(signature): Date Time <br /> qu <br /> Relinquishedby(si tore): late Time Re ivedby(signature): bate 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 />