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S�I a� r <br /> , GeoAnalytical Laboratories, Inc. Lab Re ort # <br /> 1405 Kansas Avenue Phone(209)572.0900 <br /> Modesto,CA 9535 t FAX(209)572.0916 <br /> Phone: <br /> C fent: N + . 1 CHAIN or CUSTODY Fax: <br /> Address: t I2 t r TC(7 6 eJ�,i C , � i, To: - <br /> Zi - <br /> Project ID <br /> (Print Flame) <br /> Sampled By (Signature) T <br /> Container o <br /> " Lab ID# <br /> Sample type <br /> Date Time Sample M �1 <br /> fxaD Comp Muria P type Size z N f. <br /> 3- `3f'� - t If 7 x -:-26 35 ` <br /> x-1 1 J ,313t T <br /> 3zL <br /> t <br /> t <br /> Remarks <br /> w <br /> to ut• y nature Date T imca cd y (Signoture) Date 'rime <br /> Re tlquishlby (Sign ure) �Date Time Received Received b (Signature) CO <br /> Y( g ) Dto ate lime <br /> Relinquished (Signature)1 by ( B ) Date Iinte Receive)At Laboratory by(Signature) Date Time <br /> Site Time: Driving 7inic: Total Hours <br /> Stan: Finish: Total Noun: Start: Site Arrival: x2= <br /> Mileage Approved By <br />