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- Inc. �'� x�p°rt#GeoAnalytical Laboratories, �� =1 fS <br /> 1405 Kansas Avenue, Suite "A" Phone: (209) 572-0900 Regulatory'11*Von ® No CCs C3 Yes t3 No <br /> Modesto,CA 95351 Fax: (209) 572-0916 Regulator: <br /> Phone: <br /> Client: _ ��_f,( , Qt CHAIN OF CUSTODY Fax: <br /> Address: 2h &v �� T Original To: <br /> City 171 ( /1A Zip Reporting: C3EDF ❑ EDT <br /> Project ID plk Lab Use Only <br /> (Print Name) <, [ �`'� {............_.._....__._.........._.__. ...._.......__.. <br /> Sampled By o <br /> (Signature) Container w Q <br /> Sample type <br /> Date Time Sample ID Z Lab ID # <br /> Grab Comp Matrix Type Size <br /> _ Remarks cS� <br /> �a <br /> i <br /> i <br /> 10 <br /> 44 <br /> 3 <br /> Remarks <br /> V-o.� IFI.. �e5��( p 2 or-� I - <br /> Relinquished by(Signature D to b � ime Recei Sign re) Date Time <br /> _ -_(3 - -7— <br /> Relinquished <br /> -7— <br /> Relinquished by(Signature) Date Time Rec ed (Sig ature) Date Time <br /> Preservative Matrix <br /> 0-4°C Q-HCL Q-NaOH 0-Na2S20, 0-HN0, &H2 SO, 6-0ther eDrinking Water DWaste Water®Hazardods Waste (Water) @Soil/Solid <br /> Site Time: Time Mileage <br /> Start:,),,;I Str: Time: + �W <br /> Finish: GY� Total Hours: ry„�, Start:Driving ,/� Site Arrival: 07,�Q x2=Total: r <br /> t <br /> Turnaround 'T T ❑Standard ❑Silver Rush ❑Gold Rush ❑Platinum Rush ❑Other: Approved By: r <br />