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Ge n 1 � Lab Report# �ti 5� � � • <br /> oA a ytical Laboratoies, 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: (?01 ) '50-0&13 -- <br /> Client �' "�"( `'f G-0-w""tIAT'ki— INC' CHAIN OF CUSTODY Fax: <br /> Address dt3'1 Ue:�,]E:tA i /a11T-- Original To: <br /> City woes' Zip q5�5 <br /> i <br /> Project ID C Lab Use Only <br /> (Print Name) <br /> Sampled By <br /> (signature) 44 IZ7 <br /> Container u <br /> Sample type z '� Lab ID# i <br /> Date Time Sample ID Type Size I <br /> Grab Com Matnx <br /> 6l11CC) ►7-3Remarks 1.0 <br /> I <br /> I <br /> { <br /> } <br /> P <br /> hx <br /> h <br /> Remarks <br /> Relinquished by(Signa Date Time R by(S na a Time <br /> �to�r� oc 3�0 t 3ck1 <br /> Relinquished by(Signature) Date Time Received by(Signa re) 3 Date Time <br /> Preservative Matnx <br /> I <br /> 0.400 Q-HCL ©•Na0H Q-Na2S203 ©-HNO3 10-H2 S 04 9-0ther eDnnking Water (Waste Water 4WHazardous Waste(Water) ©SoiVSolld <br /> Site Time braving Time 71me Mileage <br /> Start Finish Total Hours Start Site Amval x2=Total <br /> Turnaround Time OStandard (]Silver Rush OGold Rush OPlatmum Rush 130ther Approved By <br />