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p <br /> r GeoAnalytical Laborat es, Inc. Lab Reort# <br /> Regulatory ©Yes ❑ No <br /> a Ord 1405 Kansas Avenue Phone: (209) 572-0900 Regulator: <br /> Modesto,CA 95351 Fax: (209)572-0916 <br /> Phone: ( ) <br /> Client: Cf 5 CHAIN OF CUSTODY Fax: { ) <br /> Address: 1 y$V oh a _ UU 4 To: <br /> city zip //�s3 7 2 <br /> Project ID Z/ 4 c [gyp ! G S-/0 /� Lab Use Only <br /> (Pant Name) ! <br /> Sampled By <br /> (Signature) Container <br /> Sample type a Lab ID# <br /> Date Time Sample ID iy <br /> Grab Comp Matrix Type Size <br /> 3/1 9 1-5!g-0 V 1"'1 W — 4, Remarks <br /> 3/ t>5 �C MIN- 1 ,4 q `j_ 1 <br /> Remarks <br /> Relinquished by(Si at ) Pate Time Mv d by(SignatureDate Time <br /> Relinquished by(Signature) Date Tnre eceived by(Signal re) Date Tme <br /> I <br /> Preservative: 1Q-4°C Q-HCi (@-NaOH ®-Na2S203 @03 ®-H2 04 7Q-Other Q-Other <br /> Site Trow Driving Time: Total Hours <br /> Start: Finish: Total Hours: Stan: Site Arrival: x2= <br /> Mileage: Approved By: <br />