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GeoAnalytical Laboratories, Inc. Lab Report# <br /> Regulatory 1"*Yes ❑ No fl��lt <br /> 1405 Kansas Avenue Phone: (209) 572-0900 Regulator. 7�� 4 tf � 1�� <br /> Modesto, CA 95351 Fax: (209) 572-0916 <br /> Phone: (ZDy) � 6s1' �'lc7r <br /> Client: i 1102#',, &21(- CHAIN OF CUSTODY Fax: C41 <br /> Address: 35-1 A Etc-KA4-o-AJ Rk To: <br /> City / d(1 i C14• zip CI5,2 ry G l 9 �_ <br /> Project ID QA-�� /IBJ S�cK�dn� C/1 Lab Use Only <br /> (Print Name) <br /> Sampled By Q14,j 47Dom' v <br /> (Signatm-e) Container <br /> o Q <br /> Sample type e Lab ID# <br /> ample ID ` a <br /> Date Time Crib comp Maim Type Sze <br /> -�/ � D.y� 1 i 6 Remarks l <br /> 7ia 16 <br /> ,DZilE- e <br /> / Z / ISS' <br /> O �lS� i <br /> <Z P V A Jef)Z t,4 EI <br /> lS o <br /> ;�i15i1 / <br /> C6 e 6 ;/.55' l <br /> Remarks <br /> Re110 uished i alure) ate 'Thur -R ceive (Signature) J M14� <br /> Relinquished by sit)"' <br /> at ) Date Time Received by(Signature) <br /> Preservative: 1Q-4°C Q-HCI Q-Na0H ®-Na2S203 (D-HN03 (0-H2SO4 07 -OtherWSIriv <br /> ther <br /> Sile Time: 7T� {�,/�'/��/�) ( Drivingo <br /> Start: 0V Finist.1 ! Total Hours: 17 /`"J Std' z <br /> Mileage: Z — / S Approved By: <br />