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" �m <br /> .�._ <br /> Geohalytical Laboratories, Inc. Lab Report # <br /> Regulatory 0 Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209)572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> Phone: ( ) <br /> 4, <br /> Client: �•'i; / ; � (�attm� j�lae CHAIN 0 Fax: <br /> Adress: CUSTODY To: <br /> � 1 Zip <br /> Project ID I�J ��,n lC�� Lab Use Only <br /> rint Namc)�- <br /> Sampled By <br /> (Print Name) Container <br /> r �Q'i� ��' qJ, �r �i V <br /> 7 <br /> Lab [D# y <br /> Sample type * ud. <br /> Sample ID <br /> Date Time Grab Comp Matrix Type Sixe \� Remarks <br /> 7NS )j �5 r <br /> I lit, <br /> 1 <br /> Remarks e � « `-t� — E (� /1l ( t /tel C6, <br /> Relinquish by(S- natu Da Time r ece y(Signature) <br /> je ; 7z19� �l u�Pi1 z. ��� <br /> x-C <br /> Relinquished by wgnature) Date Time Received by(Signature) Date Time <br /> Preservative: (D-40C Q2 -HCI 53 -NaOH ®-Na2SZ03 D-HNO3 0-112S 04 0-0thers ®-Others <br /> Site Time: Driving Time: Total Hours <br /> Start: /,'p Finish: Total Hours: rj Start: _' .'CCI"j4 SiteAArrriival: /-0(; i'a x2= <br /> Mileage: /SyJ, /�S Approved By: �vti�� <br />