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C. Lab Report# <br /> GeoAnalytical Laboratories, In <br /> Regulatory es ❑ No A. <br /> 1405 Kansas Avenue Phone: (209) 572-0900 Regulator <br /> Modesto, CA 95351 Fax: (209) 572-0916 <br /> Phone: (Z0) <br /> Client: %/14o--�/f ipi L CHAIN OF CUSTODY Fax: <br /> To: <br /> City Liodt. C141-- Lip szYD <br /> Project IF Lab Use Only <br /> (Print Name) <br /> Sampled By <br /> (Signature) Container ,�Q /� ��� • <br /> o y i <br /> Sample type � Lab ID# <br /> Matrix Size <br /> Date Time Sample ID <br /> Grab Comp 'type V <br /> .Z-ems /Z:3'/ _� _� — / 5 /YZ K6 Remarks J <br /> /ZisD <br /> JZ:iZ E w 1-5-115- <br /> MaM <br /> V3c # <br /> t/51 -4- f <br /> (Xc�� <br /> Remarks 77 %S _c/,,. <br /> TK! <br /> Relinquished by(Signature Dale Time c vied by(Sig u Date rime <br /> Cc <br /> Relinquished by(Signature) Dale Tin c Received by(Signa re) Date Timc <br /> Preservative: 1Q-4°C &HICI (@-NaOH @-Na2S203 Q5 -HNO3 ©-H2S 04 07 -Other ®-Other <br /> Sife Timc: jjO 00 PM Driving Tull /� / /� Total Hours <br /> ,[, �'7 /y7 V J <br /> Start: ( Pinish: Total Hours: /1 S Std' // Site Artival: x2= =�l <br /> Mileage: 'S�2 - �� �/mss Approved By: M ' Tvfrt� = Y NcZS. <br />