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�*(1 n11 tical Ijaboratorles, 111C• ,,ab Report # Yes ONO <br /> 111 e O y Regulatory <br /> 1405 Kansas Avenue Phone: (209)572-0900 Regulator: A^il— <br /> Mocicsto,CA 95351 Fax: (209)572-091( <br /> . ]'hone: (2� ) <br /> _ LCHAIN of Fax. (ZOy' ) <br /> Client: CUSTODY `I'o• <br /> Adress: <br /> W go <br /> Zip Lab Use Only <br /> Project ID <br /> u � <br /> (Print Name) <br /> Container <br /> Sampled By <br /> (Print Name) Lab ID# <br /> P4 <br /> 0 <br /> FYI � �� �o� > <br /> Sample type Sample ID <br /> ^ <br /> Type six Remarks <br /> Date Time Grab Comp Matrix 21'C _ <br /> Remarks <br /> II c Ti to <br /> Time Receiv• b S''' J ure) 2 � - ` 3• r <br /> Relinqu' d y i nature) 7 Z Dale Time <br /> Da Time Received by(signature) <br /> Relinquished by i nature) <br /> ®-Others <br /> Preservative: 1Q-4°C (D-HCI (D-NaOH ®-Na2SZ03 Q5 -HNO3 ©-HZS 04 7�-Others Total Hours <br /> Driving Time: Site Arrival: x2= <br /> Site Tinte: Total (lours: Start: <br /> Starr. Finish: <br />