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UCOAnaiytical Laboraries, Inc. i.au f(UPurt it 1�!,2 c7 t 1 _l__t_ <br /> r Regulatory ❑ Yes ❑ No CC: ❑ Ye ] No <br /> 1405 Kansas Avenue, Suite "A" Phone: (209)572-0900 Modesto,CA 95351 Fax: (209) 572-0916 Regulator: Ban Joaquin Co. (Lori Duncan) <br /> Phone: ( 209 577-8186 <br /> Client: M-J • Kloberdanz & Assoc. CHAIN OF CUSTODY Fax: ( 201 J 577-8158 <br /> Address: P.O. Box 576981 Original To: Mike Kloberdanz <br /> City Modesto, CA Zip 95357 (old shell station) 12 <br /> Project 1D McDowell & Davis towing-Escalon Lab Use Only <br /> (Print Name) <br /> Sampled By <br /> (Signature) <br /> Container <br /> Sample e <br /> Lab ID# � <br /> P type <br /> Date Time Sample ID z <br /> Grab Comp Matrix Type Size <br /> g-S-Oz XWW MW-1 G Asort , 4 Remarks' 1 <br /> X WW MW--2 G Asort 4 f <br /> Y'3 2- X WW MW-3 G Asort 4 <br /> r^ <br /> 'o-700 X WW -.-Trip Blank G Voa 1 1 ) <br /> i <br /> ET-1 I <br /> 3 <br /> I <br /> Remarks <br /> Note= (Nee EDFcc 3 13*t6 , <br /> Relinquished by(Signature) Date Time Receive y(Sign ure) Date Time <br /> k- �� ry'fv �5 I 9J !03(`�) <br /> Relinquished by(Signature) Date Time Rece by(Signature)i bate' Time <br /> Preservative Matrix <br /> 044'C ©-HCl. Q-NaOH 0-Na2Sz03 0-HNO3 0-H2 S O4 ()-Other 49Drinking Water 49waste Water®Hazardous Waste (Water) ©SoillSolid <br /> Site Time: Driving Time: Time,'} �� Mileage <br /> Start: Finish: Total Hours: Start: Site Arrival: x2=Total: 01 <br /> Turnaround Time UStandard ❑Silver Rush ❑Gold Rush ❑Platinum Rush C10ther: Approved By: R <br />