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A & L WESTERN LABORATORIES, INC. <br /> 1311 Woodland Ave. #1 • Modesto, California 95351 • Phone 209-529-4080 <br /> AfAININUI.fINYONMMIN INWSnW <br /> CHAIN OF CUSTODY <br /> Client ( 'yr 7� 7 ! �'A16/A./��/Zf�� /i� Phone `1 Z <br /> Address ZJ CC to: <br /> C zip <br /> -1 <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 No ANALYSIS <br /> Con- <br /> SAMD BY:;(''" ature): farm \� `. <br /> ers REMARKS <br /> sample <br /> rim <br /> Sample Location <br /> Date Time 1 �C <br /> " <br /> Rell'r qui6hed by(;j6 e): D ty Time Received by(signatur . ; Date Time <br /> / <br /> Relinquished b 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 />