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GeoAnaiyticai Laboratories, Inc. Lab Report# <br /> A Regulatory 13 yes ❑ No CC: ❑ Yes ❑ No <br /> 1405 Kansas Avenue, Suite "A" Phone: (209)572-0900 <br /> Modesto,CA 95351 Fax: (209) 572-09I6 Regulator: <br /> Phone: <br /> Client: e zn t. A--wc- CHAIN OF CUSTODY Fax: 7- /S <br /> Address: PC. 66y= 5 71,�'$'f <br /> Original To: 1 � <br /> City ' C14- zip <br /> Project ID eject S/(�� li� _/y :s �J [f:LP I i' , <br /> (Print Name) t� Lab Use Only <br /> �y �� ` <br /> Sampled By AZfr r �� A <br /> (Signature) <br /> �r Container <br /> Sample type Q' k <br /> Date Time Sample ID z �Qr ' Lab ID# <br /> Grab Comp Matrix I Type Size <br /> X )L Remarks 11 <br /> Remarks <br /> Relinquished by(Signature) Date Time ec iv (Signature) Date Time <br /> L►;27W470 �G i <br /> Relinquished by(Signature) Date Time Received by(Signature) Date Time <br /> Preservative <br /> Matrix <br /> 4)-4'C Q-HCL ©-NaOH (I-Na2S203Q-HNO3 Q-H2 S 04 Q-0ther 4ODrinking Water 46Waste Water 4WHazardous Waste (Water) ©SOVSoiid <br /> Site Time: Driving Time: Time Mileage <br /> Start: Finish; Total flours: Start: Site Arrival: x2=Total: <br /> Turnaround Time ❑Standard ❑Silver Rush ❑Cold Rush ❑Platinum Rush ❑Other, Approved By: <br />