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�r <br />LABORATORIES <br />A & L WESTERN LABORATORIES, INC. <br />1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529.4080 <br />CHAIN OF CUSTODY <br />Client l �ry3 ,.. A <br />y . -, <br />Address_ .. I, L. -(' _ , r <br />-L-'+." 4' i Zip <br />Phone <br />CC to: <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 <br />vx <br />ANALYSIS <br />No. <br />of <br />Con- <br />taln- <br />ers <br />, <br />REMARKS <br />SAMPL��D BY: ignature): <br />;! <br />sample <br />type Sample Location <br />Date Time Grab comp. <br />Relinquished by.(signature): <br />Date <br />TimeReceived <br />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 />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 />