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Mme-- !! Geohalytical Laboratories, Inc. Lab Report # - <br /> Regulatory es ❑ No <br /> 1405 Kansas Avenue Phony. (209) 572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> /�� / Phone: ( ) <br /> Client: � /I,U� ac CHAIN Of Fax: ( ) <br /> Adress: CUSTODY To: — <br /> Zip <br /> Project ID <br /> Flu 0 C16( Lab Use Only <br /> (Print Name) J� •.� <br /> Sampled By v <br /> (Print Namc) Container <br /> `o Q Lab ID# v <br /> Sample type o v <br /> Sample II) ' / P. <br /> Date Time Grab Comp Matrix Type Sixe '\ Remarks <br /> z �7-07051 <br /> 3� <br /> D Z6 <br /> 4� <br /> Remarks <br /> Relinquished by(Signature) �IjoZle li�,e� Recei !nature )ate Time <br /> f <br /> Date link Received b (Signature)Rebnyuishcd by(Signature) Y nature) Date Time B <br /> Preservative: 1Q-40C 2&HCI (3-NaOH 4Q-Na2S203 Q5 -HNO3 ©-H2S Oa 07 -Others ®-Others <br /> Site"Dime: Driving Time: Tolal Hours <br /> Start: Finish: Total Hours: Start: Site Arrival: x2= <br /> Mileage: Approved By: <br /> f� <br />