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GeoAna tical Laboratories, Inc. Lab Report# <br /> y Regulatory Dyes [3No CC: Mes 13No - <br /> 1405 Kansas Avenue Phone: (209)572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> Phone: ( } <br /> Client: m :,-r, t o�..r r ,�z . , _. CHAIN OF CUSTODY Fax. ( } <br /> Address: ErEDF 13EDT Original To: Mi k<_ l s�,-ear rlri,rs <br /> City m r' �e sk" ntq Zip !2 3 — 13 FIELD LOGS C.0 To: <br /> r31 abo4 z•v. <br /> Project ID P Lab Use Only <br /> (Print Name <br /> Sampled By f- C.11 %01 %A <br /> (Signature - Container W Q <br /> o <br /> Sample type z <br /> P <br /> Sam le ID <br /> Date Time Grab Comp matrhi Type sire Rema <br /> SttJ3-o :3 y v.i X x <br /> %l3 , -Z <br /> of _ 4 <br /> Dw <br /> w <br /> :po Z <br /> - <br /> Remarks <br /> Relinquished by(Signature) Date 'Gime Receiv b (Signature) Date. Time <br /> Relinquished by(Signature) Date Time R ive b ignature) ate Time <br /> Preservative: Matrix <br /> 0 4000HCLONaOHO Naz%O:3©-HNO3 0-HPO, vOther Drinking Water®Waste Water QD Hazardous Waste(Water)®5oiU5olid <br /> Pump Truck Time Mileage <br /> Bailers (O 55 Gallon Drums vl <br /> Approved By: <br />