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Lab Report# <br /> GeoAnalytical Laboratories, Inc. " <br /> Regulatory ❑Yes ❑ No CC: ❑Yes ❑ No <br /> 1405 Kansas Avenue, Suite "A" Phone: (209)572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> _ Phone: ( ) <br /> Client: f e- CHAIN OF CUSTODY Fax: (-70C ) `� - <br /> Address: (J- c� Original To: <br /> City Zip Reporting: )ODF U EDT <br /> Project ID A& Lab Use Only <br /> (Print Name) J <br /> Sampled By <br /> (Signature) Container U Q' <br /> Z 4 <br /> Sample type <br /> Date Time Sample 1D a, <br /> Grab Comp Matrix Type Size <br /> _ r./ i Remarks: <br /> i <br /> 3F F <br /> f Y <br /> x <br /> � 9 <br /> L! <br /> Remarks <br /> Relin hed y(S' tire) Date Time <br /> Q� Receiveby(Si md <br /> R inquish by(Signature) Date Time Received by(Signature) / Date Time <br /> Preservative Matrix <br /> Q-4°C 0-HCL Q-NaOH Q-Na2S203 Q-HNO3 Q-H2 S 04 j)-0ther 49Drinking Water ®Waste Water 4WHazardous Waste(Water) ©SoillSolid <br /> Site Time: Driving Time: Time Mileage <br /> Start: Finish: Total Hours: Start: Site Arrival: x2=Total: <br /> Turnaround Time ❑Standard ❑Silver Rush QGold Rush ClPlatinum Rush ❑Other: Approved By: <br />