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�> A & L WESTERN LABORATORIES, INC. <br /> z 1311 Woodland Ave. #1 • Modesto, California 95351 a Phone 209-529080 <br /> ' nGAiCU:AUAaE Etrvi40W/.fNGI wWSiRW� <br /> CHAIN OF CUSTODY <br /> Client L�) Sr�� �! rt��c�SG'�7rrv' Phone <br /> Address CC to: <br /> 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 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 No. ANALYSIS <br /> _ <br /> �/� of J Q <br /> Li v',r <br /> r <br /> Con- <br /> SAMP4E'D BY: (sig ;lure): tain- �� <br /> X" <br /> ers rY) \ REMARKS <br /> ev <br /> sample // • <br /> type Sample Location <br /> Date Time <br /> Grab comp. <br /> 1t1 r>L 'f ! '-VV'J `! <br /> R gJished (s" nature): Qate/ Time Received by(signature): Date Time <br /> 1 i/ <br /> r <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 /> 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 />