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# Iv <br /> GeoAnalytical Laborato*S, Inc. Lab Report <br /> Regulatory ❑ Yes ❑ No CC: ❑ Yes <br /> 1405 Kansas Avenue, Suite "A" Phone: (209) 572-0900 Regulator' <br /> Modesto,CA 95351 Fax: (209) 572-0916 ' <br /> -- Picone: ( } <br /> Client: CHAIN OF CUSTODY Fax: ( ) <br /> Address: W7 Original To: ,LL <br /> City zip Reporting: ❑ EDF ❑ EDT <br /> Project ID & e-&t4 O,LI /� � �i _ -Lab Use Only <br /> Sampled By <br /> (Print Na e) _. ------ <br /> (Print <br /> --- � <br /> P <br /> (Signature) Container " 9 <br /> Sample type 6 �X Lab ID# <br /> Date Time Sample ID TyPe size a <br /> �3rah Comp Matrix � <br /> VO4 3 Remarks, O? <br /> I <br /> Remarks <br /> Relinquished by(Signature) Date Mme Jaeceived by(Signatu Qate Time <br /> .N5 <br /> Relinquished by(Signature) Date Time Received by(Signature) Pad Time <br /> Preservative <br /> Q-4°C Q-HCL Q-Na0H Q-Na2S203 Q-HNO3 (D-H2 S 04 ()-Other (DDrinkirig Water tawaste Water4WHazardous Waste(Water) ©SoiVSotid <br /> Site Time: Driving Time: ��/YrQ 7� G Time Mileage <br /> Start: Finish: Total Hours: Start: Site Arrival: //Fetal: <br /> Turnaround Time ❑Standard ❑Silver Rush ❑Gold Rush ❑Platinum Rush C]Other: Approved By: <br />