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1%V <br />GeoAnalytical Laboratories, Inc. <br />1031 Kansas Ave., Suite C <br />Modesto, California 95351 <br />CHAIN OF CUSTODY <br />Client C67 N/06 /Z / 12 LC9CL,� <br />Address <br />Zip- <br />CV, <br />ip <br />Phone (209) 572-0900 <br />Fax #(209) 572-0916 <br />1984 <br />aF p �-5 <br />Phone <br />CC to: <br />CCI• DEQ: &AU-tr <br />PROJECT ID <br />a3oS <br />ANALYSIS <br />No. <br />con <br />an- <br />ers <br />�� <br />-oa <br />REMARKS <br />SAMP D BY: (sign re) <br />gf.,.., <br />sample <br />tyF <br />Date a Sample Location <br />Grab Comp. <br />.1 5W5 A.18r�! <br />., <br />t3 �( '' <br />Relin ished by (si re): <br />Date <br />K yJ D <br />Time <br />3:c <br />Re 'ved y (sign,ture): <br />ate <br />13 0 <br />Time <br />3 <br />Reli shed by (sign re): <br />Date <br />Time <br />Received by (signature): <br />Date <br />fime <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Relinquished by (signature): <br />Date <br />Time <br />Received by (signature): <br />Date <br />Time <br />Site Time: <br />Start: Finish: Total Hours: <br />Driving Time: <br />Start: Finish: <br />Total Hours: <br />