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A & L WESTERN LABORATORIES, INC. <br /> E _ 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> '�GRKIIINGI. AOrw.EN1.0 intWSivu <br /> CHAIN OF CUSTODY <br /> Client ii 1-'111111�': i'';l; i U��i i/�'7 i /'—rFz <br /> �- -- Phone <br /> Address e' i2 ' <br /> f cc to: <br /> !f7zip JZ <br /> r� <br /> Signature of person authorizing world/ ZJ� <br /> under terms stated below* ,f <br /> 'Net 30 days. All accounts past due will be subject to interest char/es 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 Il INo ANALYSIS <br /> /, of t„ <br /> SAM) 4�ED BY: (sj njoture): to°n-`Lx <br /> ers REMARKS <br /> mple <br /> Date Time type Sample Location <br /> Grab Comp. <br /> Reliru//ihed by( ture): _Pato 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 /> 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 />