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­SIR? III SILUUI l Ul)� 111U. Lab Report # <br /> 1405 Kansas Avenue <br /> Modesto,CA 95351 Phone: (209)572-0900 RegulatoryyeS ❑ No <br /> I . I/�� Fax: (209)572-0916 Client: -7 Regulator: (� <br /> _j I <br /> �Adress: Phone:f Y33b` re-, r��h ma _ ._� <br /> V e <br /> CUSTODY rax: (20f) <br /> Project ID <br /> zip q5"3 7 TO: ©ky E Z r! , �✓z— <br /> Sampled lay (Pnn( ante) <br /> (Print Nante) ;ep �ti� (,t Lab Use Only <br /> �______---.. Container �� (i► <br /> Santplc type u° <br /> Katt; Time Grab Comp S.1111Ple p <br /> II) � <br /> I Matrix ° Lab ID#Type Sixe <br /> Z <br /> L <br /> ` l Ll liJ t /t Remarks a' <br /> x016 <br /> Remarks <br /> Relinquished by(Signature) <br /> Relinquished by(Si1'imn� <br /> gnature) R ec'v <br /> S"z � )y Si <br /> nate - (,- <br /> Pre <br /> Time s _ 7��e. Time <br /> servative: _qo Iteceivcd by(Signature) <br /> 0 C 0-HCI 3 - <br /> site Time: O NaOH ®-Na 2S1O3 5O-HNO 6 _ nate Tina; <br /> Start: �Ay,,�/,� Bp 3 O HZS OQ Q-Others <br /> /`rI'', Finish: ®-Others <br /> Total Hours: -[25 Driving Tint <br /> Mileage: l _ start: <br /> Z Site Arrival: © x � 1' (al I t s <br /> Approved fly: TJX <br />