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GeoAnalytical Laboratories, Ince <br />1405 Kansas Avenue, Suite "A" <br />Phone: (209) 572-0900 <br />E*3 Modesto, CA 95351 Fax: (209) 572-0916 <br />hA <br />Client:t� n�1 <br />Address: 2-a- L i 1 )0 tib►" <br />City �(A Zip <br />Project ID r. innok , o. i� <br />Sampled By <br />Date Time <br />I /o"9 <br />Remarks <br />(Print Name) <br />Y ('Ci CX_ <br />(Sibnature) <br />Sample type <br />Grab Comp Matrix <br />Relinquished by (Signature) <br />Relinquished by (Signature) <br />Sample ID <br />CHAIN OF CUSTODY <br />Lab Report # C- /3, <br />Regulatory ❑ Yes ❑ No CC: ❑ Yes ❑ No <br />Regulator: <br />Phone: ab 'I) g _ 3 n moi" <br />Fax: ( ) <br />Original To: <br />Aq <br />Container U �� <br />z �f <br />Type Size <br />71 -5f, G i <br />CAJ <br />Tintc <br />Date I ' Ting I Received by <br />Lab Use Only <br />a� <br />ca <br />Lab ID # <br />a <br />Date <br />0 <br />G, Matrix <br />Preservative <br />Q- <br />(1 -40C Q HCL Q-NaOH Qresery t©-HNO, Q -HZ S 0� Other Drinking Water kwWaste Water (Hazardous Waste (Water) ©SoiUSolid <br />Time Mileage <br />Site Time: Driving Time: <br />Start: finish: Total Ifours: Start: Site Arrival: x2=Total: <br />Turnaround Time ❑Standard ❑Silver Rush ❑Gold Rush ❑Platinum Rush ❑Other• Approved Uy: <br />