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Lab Report# <br /> GeoAnalytical Laboratories, Inc. . <br /> Regulatory ❑Yes El No CC: L3 Yes © No <br /> ' 1405 Kansas Avenue, Suite "A" Phone: (209) 572-0900 <br /> Modesto,CA 95351 Fax: 209 572-0916 Regulator: <br /> Phone: Vf)q) <br /> Client: CHAIN OF CUSTODY Fast: (may V t <br /> Address: Original To: <br /> City Zip q 6 9S 2 Reporting: EDF ❑EDT <br /> Project ID � ,� <br /> � Lab Use Only <br /> (Print Name} S <br /> Sampled By �' law <br /> °' <br /> gJrll— <br /> (Si ° N <br /> nature) �1_� Container Q' x <br /> W <br /> Sample type <br /> Date Time Sample ID z Lab ID# E <br /> Grab Comp Matrix Type Size a <br /> ozss °` ItJ Y ' ✓ V U, Rema <br /> rks <br /> 02 J- <br /> d <br /> FI <br /> 1 3 <br /> 3 <br /> Remarks <br /> Relinquished by, i atur Date T'Ame Received by Si store) D to Time <br /> i, �. -�.-a • iS <br /> Relinquished by(Signature) Date Time 7Recei ed y(Si amre) IDAe Time <br /> Preservative Matrix <br /> Q-4°C 16-HCL Q-NaOH O-Na2S203 0-HNO3 0-H2 S 0, 8-0ther IsDrinking Water 4&waste Water 4WHazardous Waste(Water) ©SoiVSolid <br /> Site Time: <br /> Driving Time: Time Mileage <br /> Start: Finish: Total Hours: Start: Site Arrival: x2=Total: <br /> Approved By: <br /> 7Lrnaround Tune ❑Standard ❑Silver Rush OGold Rush ❑Platinum Rush ❑Other: <br />