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IEAtL <br /> A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-5294080 <br /> CHAIN OF CUSTODY <br /> {r woo <br /> Client Phone <br /> +�7'a�7�� v�7u! T�NG�Z Phone <br /> w, Address d• 8�X ��'Q CC to: <br /> T RLOG '� Zip <br /> Signature of person authorizing work <br /> under terms stated below' <br /> 'Net 30 days. All accounts past due will be subject to interest charg 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 /> PROJE T ID r ANALYXQVXXIII <br /> Q 1 /� Con- <br /> y of <br /> SAMP BY: (s ure): tain- <br /> ers (✓ REMARKS <br /> sampletype Sample Location <br /> Date Time Grab Como <br /> Relin shed by rej: Date Time Reive 6y(sign lure):/ Date Time <br /> / <br /> Relinquished y(signature): Date Time ewed 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 />