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n 1 real Laboratories . Lab Report# <br /> GeoA a yt , Inc <br /> Regulatory ❑ Yes © No <br /> 1405 Kansas Avenue Phone (209) 572-0900 Regulator <br /> Modesto, CA 95351 Fax (209) 572-0916 <br /> Phone. ( ) <br /> Client ; MGD CHAIN OF CUSTODY Fax ( ) <br /> Address To <br /> City Zip <br /> Project 10 S aC: -F6n<- 2v,4Lab Use Only <br /> (Print Name) a ~� <br /> Sampled By <br /> GeQ4 <br /> (Signature) Container U �Q <br /> QAAJR <br /> Sample type , Lab ID# ti <br /> Sample ID <br /> Date Time Q <br /> Grab Comp Matrix Type Size h <br /> 6— G( 1� L �� Remarks 1 �� <br /> Remarks <br /> Relinquished by(Signature) Date Time R e S t r Date Time <br /> 6 g,L Ela" LAL� �5 3 <br /> Relinquished by(Wature) Date Time tCLivLd by(Sigmit e) ]late Time <br /> Preservative Q-4°C &HCI (@-NaOH Q-Na2S2o, &HNO, ®-H2S' 4 Q-Other &Other <br /> Site Time Dnving Time rural htours <br /> Start 7 /p Finish Z 1{t] Total Hours Stan Site Arrival x2- <br />