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n ° Lab Report# `19\ <br /> eoAalyt>Ical Laboratories, Inc. <br /> Regulatory *Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209) 572-0900O6ttfS d�V <br /> &Q"f C' <br /> Modesto,CA 95351 Fax: (209) 572-0916 Regulator: ��/ <br /> Phone: (2dq <br /> Client: ®/C CHAIN OF CUSTODY Fax: Qog <br /> Address: r To: ( �� <br /> City C1 Zip U <br /> Project ID �4 Lab Use Only <br /> (Print Name) <br /> Sampled By Z <br /> (Signature) Container uw s'. <br /> Sample type Lab ID# <br /> Date Time Sample ID <br /> Crab Comp Matrix Type Sire Cr <br /> 72-`+t`i' 9,' C e� �� t � � Remarks t <br /> Z�l Z Gd/tt e/ <br /> Remarks y/5 <br /> O(t-- /&. 1•-19mkJ L fF r`ilric /'ytrt:v Z©Ala e4zi41 ✓ i�iD . <br /> Relik luished by(Signature) D.1je Time Received by(Signature) Date tion <br /> ILelinquisheJ b (Signature) Date Ti nn W/TiAwn.'o'; <br /> / Dat TiD7- Z-`/1 /1 l�� y�f 121 <br /> �� <br /> Preservative: 1Q-4 ®-HCI ®-NaOH ®-Na2S203 &HNO3 &H 2S 40r 70-0ther -Other <br /> ' SiteTinn: �067�> Driving Time: Total flours <br /> Start: finish: 11 Total Hours: Stan: Site Arrival: x2= <br /> Mileage: Approved By: <br />