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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> AGAINIWW•E-ON W&•IN-A <br /> CHAIN OF CUSTODY <br /> Client Phone <br /> / <br /> Addresso +' 3 % "r CC to: <br /> (` 1. i) Zips J �> <br /> �^f <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 J C No ANALYSIS \� <br /> Con- <br /> SAM <br /> n-SAM D BY: ( tune): tan � `. v <br /> ers REMARKS <br /> Date Time type Sample Location <br /> Grab Cane. <br /> vX <br /> R�4 uished by s ature): gat Time Received by(signature) Date Time <br /> -71 <br /> Relinquished by(signature): Date Time Received by(sigpatur�): d 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 />