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mm IN q111110111ww', <br /> 0 0 V, 1-3 - 19 <br /> eoAnal tical Laboratories, Inc.WoLab Report# <br /> y Regulatory // Yes ® No �1 <br /> 1405 Kansas Avenue Phone: (209) 572-0900 Regulator: <br /> Modesto, CA 95351 Fax: (209) 572-0916 <br /> Phone: ( ) <br /> Client: CHAIN OF CUSTODY Fax: ( ) <br /> AddressTo: 1%Jt <br /> City t Zip Q wag/—/�1 /6( /t <br /> Project ID Lab Use Only <br /> (Print Name) �� <br /> Sampled By ° <br /> (Signature) Container / <br /> Sample typeple ID z Lab ID# co <br /> Date Time Grab Comp Matrix Type Size <br /> P 4 ; X Remarks UZ0 ISS <br /> 2 <br /> S 4k I <br /> IC.za i S <br /> w 1 S1 <br /> C ILO <br /> a <br /> ds Z <br /> 2 19 <br /> � v <br /> �I <br /> Remarks <br /> Relinquished by(Signature) /1' Date Time Received (Signature) D to Time <br /> Relinquished by(Signature) Date Time Received by(SV-) <br /> Sre) Dat Time <br /> ' u <br /> Preservative: 1Q-4°C 20-HCI (@-NaOH @-Na2S203 5&HNO3 ©-H2S 04 -O her ®-Other <br /> Site Time: Driving Time: Total Hours <br /> Start: Finish: Total Hours: Std: Site Arrival: x2= 2'1Z_ <br /> Approved B <br /> Mileage: . �Z' � APP Y: <br />