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A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 953511 • Phone 209-529-4080 <br />CHAIN OF CUSTODY <br />Client <br />Address <br />ZLE,(� -Zip <br />>� <br />Signature of person authorizing work <br />under terms stated below' <br />Phon� _9 �` 4 4)"? — L6�� <br />CC to: <br />`Net 30 days. All accounts past due will be subject to interest ch ges 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 <br />/AI <br />1 ^7� <br />1 J <br />No. ANALYSIS <br />of <br />Cn- <br />ain- <br />ers <br />/ <br />; /J <br />�� <br />REMARKS <br />SAMP T BY: (Sig re): <br />/ <br />sample <br />Date Time type Sample Location <br />Grab Comp. <br />1 <br />f <br />Reli 4u shed by (i ri e): <br />9 <br />t l <br />Relinquished by (~signature): <br />t <br />Date <br />Time <br />Time <br />Received b (signature)- <br />�Y Y ( 9 ) <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: <br />Total Hours: <br />Driving Time: <br />Start: Finish: <br />Total Hours: <br />Dedicated Exclusively to Providing Quality Analytical Services <br />