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1 I_ I- <br /> nal tical Labor Inc. LaU Rt:Port # <br /> �..- -� G e o A y <br /> Regulatory Yes ❑ No <br /> .1405 Kansas Avenue Phone: (209) 572-0900 Regulator: ��lv u` ' <br /> Modesto,CA 95351 Fax: {209) 572-09 6 V <br /> Phone: (0�fl -6-7 7 <br /> CHAIN OF CUSTODY Fax- ( } X77 ^� / <br /> Client: . <br /> Address: 70 _ < To: 11< <br /> City 6 S`Lo CIS- Zip S <br /> Project ID 8 Mho <br /> C '} f�� � � �Q� Lab Use Only <br /> (Print Name) <br /> Sampled By <br /> (Signature) �, Container <br /> o Lab ID# a <br /> Sample type 4 <br /> Date Time Sample ID Size <br /> Grab Comp NEatriz <br /> C, 40� x Remarks <br /> 7-23 `y /00 7 <br /> -2- x �+'A <br /> Remarks <br /> AIT <br /> Relinquished by(Signature) Dat -rine t °c "t' u e Date Time <br /> z:,, tiz�C( <br /> Rdiuquished by(Signature) Date Time eectved by tSignatu Date Time <br /> Preservative: 1Q-4°C 0-HCI (5)-NaOH 4Q-Na2S203 Q5 -HNO3 ©-H2S 04 (D-Other ®-Other <br /> Site Tune: 2 // Driving Time: ' 3 >�/f9.�i STolaf Hours <br /> Start: Finish: !r Total Hours: A7/ Stam. Site Arrival: <br /> Mileage: _ � — 70 _ Approved By: ,r <br /> L <br />