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l• r__r �■1 r r r r r ® �r rr �r r r � r r� r� �r <br /> Lab Report# L �— <br /> GeoAnal tical Laborat'Ries, Inc. <br /> � � Regulatory Yes ❑ No CC: es ❑ No <br /> 1405 Kansas Avenue, Suite "A" Phone: (209) 572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: (AJ CE) - <br /> Phone: ( ) - evzs-�5) <br /> Client: CHAIN OF CUSTODY Fax: ( ) <br /> Address: P Q• bQ?C LIZ 7 ___ __ Original To: GL <br /> City (r-w<1 4L,r— -,CA- Zip 75- l <br /> - Lab Use Only <br /> Project ID 1jC�r,ETl 1��20G�Ll�yt �`j � � 4 <br /> (Print Name) , l ��4�C ��� c <br /> /C C B <br /> Sampled Samp Y <br /> 9: <br /> Ay <br /> 0 I1Ix <br /> (Signature) Container U <br /> Sample F type Z <br /> Lab ID# a <br /> � <br /> Date Time ID <br /> 6-Sample �� slae 0. <br /> Grab Comp Matrix <br /> L 7-1 X K I I Remarks;l-- L) 7Z <br /> �312.g <br /> Remarks <br /> Relinquished by.(Signatt re) Date Time Rccei d by(Signature Date Time <br /> 6 2,0D <br /> Relinquished by(Signature) Date Time Received ( nature) Date Time <br /> Preservative Matrix <br /> 0-4°C Q-HCl- Q-NaOH Q-Na2S20, 0-HNO3 (D-1-12 S O, G-Other ©Drinking Water l)Wasle Water 4WHazardous Waste(Water) ©SoillSolid <br /> Site Time: Driving Time: Time Mileage <br /> Stat: Finish: Total flours: Start: Site Arrival: x2=Total: <br /> Turnaround Time ❑Standard ❑Silver Rush ❑Gold Rush ❑Platinum Rush ❑Other: Approved By: <br />