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�• Lab Report# of; <br /> '- ' '0-,.r 0 <br /> GeoAnalytical Laboratories, Inc. <br /> Regulatory LI Yes ❑ No CC: Q Yes 0 No <br /> ' 1405 Kansas Avenue,Suite"A" Phone: (209)572-0904 <br /> Regulator: <br /> Modesto,CA 95351 Fax: (209)572-0916 <br /> Phone: <br /> Client: Oa L XJ 4? Q � CHAIN OF CUSTODY Fax: <br /> Address: Z riginaI os <br /> City <br /> r �J� Zip <br /> - <br /> Project ID Lab Use Only <br /> (Print Name) � 9 r"N. <br /> Sampled By ti .xs <br /> (Signature) Container U <br /> Sample type LAID U <br /> Date Time Sample ID Size µ, <br /> Grab Com Matrix t1e <br /> Q lJr ll-• 2,>( Remarksk <br /> 1 <br /> (,j fj1 fJ ZM/elf` y;. <br /> k <br /> Remarks <br /> Relinquished by.(Signature) <br /> a �D Rem <br /> Relinquished by(Signature) ate Time ived by(Signature) Date Time <br /> Preservative Matrix <br /> Q-4°C 10-HCL Q-Na0H Q-Na2sA Q-HNO3 Q-Hz S 04 Q-Other 49Drinking Water®Waste Water IWHazardous Waste(Water) QSoiMolid <br /> Site Time: Driving Time: Time Mileage <br /> Start: Finish: Total Hours: Start: Site Arrival: x2=Total: <br /> 7Lmaround Time OStandard ❑Silver Rush OGold Rush OPlatinum Rush OOther: Approved By: <br />