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W—Mmazz <br /> Lab Report# <br /> eoAalytical Laboratories, Inc. <br /> Regulatory El Yes ❑ NoF-��w /;Z,, <br /> 1405 Kansas Avenue Phone: (209) 572-0900 <br /> Regulator: <br /> Modesto, <br /> JCrt�I�tiUA <br /> Modesto,CA 95351 Fax: (209) 572-0916 <br /> Phone: ( ) <br /> Client: oe"t l_I'1/t^��� CHAIN OF CUSTODY Fax: <br /> Address: P ��% To: - <br /> City NML&jj L, C Zip <br /> Project ID arm � � Lab Use Only <br /> d �� <br /> (Print Name)/,;I 9� J � P. <br /> Sampled By C I <br /> (Signature) Container 0 r <br /> Sample type o Lab ID#Date Time Sample ID ZType size p' <br /> Grab Comp Matrix <br /> Remarks Tib 10 <br /> G <br /> wt <br /> CZ6 t-7 <br /> 5) <br /> WY <br /> Remarks <br /> Relinquished by(S azure) DateTimReceive y(Signature atTime <br /> r ,�.. <br /> Relinquished by ignature) Date Time R ived y -g t e) Date Time <br /> \VL <br /> Preservative: Q-4°C 0-HCI Q-Na0H,:,:®-Na2S203 D-HNO3 ©-HZS 04 7 -Ot er ®-Other <br /> Site Time: <br /> Driving Time: Total Flours <br /> Start: Finish: Total Hours: Sty' Site Arrival: x2= <br /> Mileage: _____—_._ Approved By: <br />