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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> UICUlNR.4 NVIgONUENiY MWSiPIN <br /> CHAIN OF CUSTODY <br /> ;�, � � � � G '+�{1 �lkl� Phone 'J <br /> Client.—C. i:. i � � U I L r <br /> Address E. CC to: <br /> "TL4 !Z nC�I (.A Zip <br /> Signature of person authorizing work <br /> under terms stated below* a '/ iG y c f <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 ANALYSIS <br /> No. <br /> of <br /> Con- <br /> SAMPLED BY: (signature): tain- ^�( <br /> ers REMARKS <br /> sample h <br /> Date Time type Sample Location J <br /> rild� Com D �� <br /> i <br /> L' <br /> Rel}ryquished by�gn <br /> re): D7te Time Received by(signature):. Date Time <br /> / 1 <br /> Relin 'wished (signature): Date Time Received by(signature): Date v Time <br /> i <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): DateTime 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 />