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i i i i i i� i i i i i � s• � � <br /> • '�• Lab Report# <br /> GeoA,nalytical Laboratories, Inc. <br /> Regulatory Yes © No <br /> 1405 Kansas Avenue Phone (209) 572-0900 p <br /> Modesto, CA 95351 Fax (209) 572-0916 Regulator S ��� � <br /> Client i� CHAIN OF CUSTODY Fax (ZIT ) r <br /> 'a 5-7G� TO. hr'j �55�� <br /> Address . !a �- O l _ <br /> Citylock ' C'+ Zip 9 3S7 <br /> -7th? � o�y4� ,-e— Ltd Lab Use Only <br /> Project ID {�{ /4- — `7 � <br /> (Print Name) ° �~ <br /> Sampled By Zf`v k <br /> (Signature) Container <br /> Sample type Lab Ill# F <br /> Date TimeGrab Comp <br /> Sample ID Type s17C <br />� <br /> ��, 147 Remarks <br /> � 7 � f <br /> Remarks <br /> Relmyuislaad by(Signature) /��� Time <br /> n00 ved by(Sir ) i Zf eel E i 1 " „} <br /> Relinquished by(5rgniture) Dale Trite Rec.erved by(St ralure) Date Time <br /> Preservative @-40C2&HC] @-NaOH ®-Na2S203 Q5 -HNO3 ®-H2S 04 Q7 -Other ®-Other <br /> 5u�Tunc (� Driving Tini Total Hours <br /> 4rart p Finish Total Hours Start Site Arrivalx2= <br /> Mileage. Approved By: <br /> I <br />