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L A 6O R AT O R I ES <br />A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br />CHAIN OF CUSTODY <br />ti <br />Client—.I/'- � ''� t` ;'� � i<.l.''' •',, <br />7 <br />Address <br />0 Zip �f t' <br />Signature of person authorizing work <br />under terms stated below' <br />Phone `/1 0.7 <br />CC to: <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 f <br />No ANALYSIS <br />of <br />Con- <br />tain- <br />ers <br />4,j <br />;y; <br />' v <br />REMARKS <br />SAMPLED BY: ature): <br />R <br />'sample <br />,yp, <br />Date Time Sample Location, <br />Grab Comp. <br />Relinquished by (signature): <br />Rehlri uishe y(signaturey <br />Date <br />Date <br />Time <br />Time <br />Receivel by (signature): <br />Received by (signature): <br />Date <br />Date <br />Time <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 />