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• Lab Report# ` b�r�Z 'J <br /> ��-- - GeoAnalytical Laboratories, Inc. <br /> Regulatory 0 Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209) 572-0900 Regulator: <br /> Modesto,CA 95351 Fax: • (209)572-0916 <br /> r Phone: ( ) <br /> Client: _r a L� {� t LL,.� �, . — CHAIN OF CUSTODY Fax: { ) <br /> Address: 2_7-nZ 3 <br /> fl 0 V1 ('7"OETE )X To: <br /> City �--D Zip <br /> Project ID e L 1 z _ Lab Use Only <br /> (Print Name) �� <br /> Sampled By . U <br /> (Signatur Container �� f9 <br /> o Lab ID# <br /> Sample type L <br /> Sample ID <br /> Date Time Grab Comp Matrix Type Size a' <br /> A Remarks L 3 S 1 'O . <br /> lD 2 t.- 3 sr <br /> ,-- W z L 3 s r <br /> ,r sL L Z l G Z <br /> LZ I 6 z <br /> Remarks <br /> Relinquished by(Signature Dat irne Received by(Signature) Dat Time <br /> .4- <br /> Relinquished by(Signature) V , 220 <br /> ate Time Receiv <br /> AX; d (Signature) Dae Time <br /> Preservative: ®-4°C &HC1 &NaOH &Na2S203 QQ -HNO3 &H 2S 04 @-Other ®-Other <br /> Site Time: Driving Time: Total Hours <br /> Start: Finish: Total Hours: Start: Site Arrival: x2- <br /> Mileage: Approved By: <br />