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mirm d�3 <br /> - GcoAmIlytical Laboratories, I»c. Lab Report # <br /> 1405 Kansas Avenue Phone: (209)572-0900 Regulatory es 0 No <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> Phone: ( ) <br /> Client: �L� CHAIN QJf Fax: ( ) <br /> Adress: CUSTODY To: fgYt/ l o-'L►2� <br /> Zip <br /> Project ID Lab Use Only <br /> (Print Name) <br /> Sampled By 5 N <br /> (Print Name) Container eZ� �� •> <br /> U <br /> QF <br /> Sample type "Lab ID# <br /> Sample ID z ! <br /> Date Time Grab Find <br /> Matrix Type Sixe r\ Remarks w <br /> 2� //3'! S Z 5Z oho <br /> ( 3 —1 132oZ� <br /> 3�l I <br /> Zo <br /> �l <br /> l <br /> Remarks <br /> Relinquished by(Signature) } �fY $.aTime• <br /> ReceitrTnatur <br /> Relinquished by(Signature) nate Time Received by(Signature) Date Time <br /> Preservative: iQ-4°C (D-HCI (5-NaOH ®-Na2S203 &HNO3 ©-H2S 04 70-0thers ®-Others <br /> Site Time: Driving Time: Total Hours <br /> Start: Finish: Total Hours: Start: lom� <br /> SiteeArrivval: x2= <br /> Mileage: Approved By: <br />