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Lab Re ort# <br /> o3 <br /> �-- --••� GeoAnalytical Laboratories, Inc. P <br /> Regulatory ❑ Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209) 572-0900 <br /> Modesto, CA 95351 Fax: (209) 572-0916 Regulator: <br /> Phone: ( 209 ) 531- x(40 <br /> Client: (!.L� a r i ja Ai I nr; CHAIN OF CUSTODY Fax: ( 2-oci) 53 7 - /56-5 <br /> Address:_ a,31 C easy- To: <br /> City M Ocl&Is+a C_A zip 95.3!T y <br /> Project ID (re�-tJ- Go 57.x} � r A � <br /> Lab Use Only <br /> (Print Name) <br /> Sampled By G l <br /> (Signatur CU <br /> �7 Container <br /> Sample type Sample ID z e ,��. pkv v Lab ID# <br /> Date Time rs. <br /> Grab ornp Matrix p Typc Size <br /> Remarks (, <br /> i <br /> Remarks <br /> Relinquished by(Signature) Date Time ce' y(Signature) Date Tirne <br /> Relinquished by(Signature) Date Time Received by(Signature) Date Time <br /> I <br /> Preservative: 1Q-4°C 2&HCI Q-NaOH &Na2S203 5&HNO3 ©-HZS 04 7Q-Other ®-Other <br /> Site Time: Driving Time: z / Qj Total Hours <br />` Start: Finish: ID: Total Hours: Std' J U Site Arrival: p x2= <br /> f <br /> Mileage: f Q 0 Approved By: <br />