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Lab Re ort# D- J )- D <br /> -- GeoAnalytical Laboratories, Inc. <br /> Regulatory D Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209)572-0900 Regulator: <br /> Modesto,CA 95351 Fax: (209)572-0916 <br /> Phone: ( } <br /> Client: CHAIN OF CUSTODY Fax: { } <br /> Address: 6 7 c` /d To: <br /> City Zip 9.5"3 7A, <br /> Project ID 4r t: Lab Use Only <br /> (Print Name) C cwt! 'rp <br /> Sampled By y <br /> (Signaturc) Container IT °r <br /> Sample type $am le ID Lab Ib# <br /> p <br /> Date TiitnC Crab I Camp Mmrrix Type Size A. <br /> G / Remarks (o <br /> A 4- IN 4-* f f 1 / 1I <br /> a ' -� it 11 lc, D <br /> 4- 1 '9*(' ,'A-� 6 -t ! <br /> ►S A* (f <br /> 4 ij 44- <br /> t K A k- IQ 4-+- ! l <br /> lra�" A 4. 1i <br /> 3 - <br /> Remarks <br /> by( ' ) Date Time by lSignmtam Tim <br /> Relimpisbed by(Sigamture) Die Time Re4ivcd by(Signature) Date Time <br /> Preservative: Q-4°C ®-HCl ®-NaOH @-Na2S203 �}5 -HN09 0-H2S O, @-Other @-Other <br /> Site Time: Driving Time: Total Hours <br /> Start: Fisk Totml Hour: Stmt: Site Arrival: x2. <br /> Mileage: Approved By: <br />