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-�--• Lab Report# <br /> GeoAnalytical Laboratories, Inc. <br /> Regulatory ❑Yes El No <br /> 1405 Kansas Avenue Phone: (209) 572-0900 <br /> Modesto,CA 95351 Fax: (209) 572-0916 Regulator: <br /> Phone: (aoS) �_�36 <br /> Client: /� ri«h �„ ,,��, �� f CHAIN OF CUSTODY Fax: (aal <br /> Address: C7 �/�•>'' /c%'f�' Str��•>< <br /> To: <br /> City Zip q.53 7� <br /> Project ID eZ Vis /71..c•i 1)AWWT- Lab Use Only <br /> (Print Name) <br /> Sampled By <br /> (Signature) " <br /> y Y w <br /> Container U <br /> Sample type Q' ��� v <br /> Date Time Sample ID z Lab ID# <br /> Grab Comp Matrix Type SizeLZ <br /> lel' Remarks <br /> Remarks <br /> Relin wished by(Signature) Date Time ecei y(Signature) Qatc Time <br /> Ce <br /> CkA <br /> Relinquished by(Signature) D to Time Received by(Signature) Date Time <br /> Preservative: 1Q-4°C ©-HCI Q-NaOH &Na2S203 0-HNO3 0-H2S 04 Q-Other ®-Other <br /> Site Time: Driving Time: Tot Hours <br /> Start: 1'4)C 4m Finish: :C'e) Total Hours: Start: L Site Arrival: ��. .�x2= le.. <br /> ��/ <br /> Mileage:_3 -r i;T, Approved By: L ^ -- <br />