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--- - GcoAnalytical Laboratorif, Ync. <br /> Iteguiatory ❑ Yes ❑ No <br /> 1405 Kansas Avenue 1'11011c: (209) 572-0900 Reguintor: <br /> Modesto.CA 95351 Fax: (209) 572-0916 <br /> 2 - �b Z <br /> Client: A C _ CHAIN oI, CUs'rODY rax: ( ) <br /> 532 <br /> Address: l N 7 MDno 7o. C-7(M- <br /> oily So <br /> )n cr4 c Pj- Zip�S 3 7D <br /> Traject 1D 11'r a c C-DI d S fC, Lab Use Only <br /> (Print Name) .�C <br /> Sampledjl}, G y l� <br /> o ro <br /> (Sibn:uurc} /� Coltt:tiner v <br /> Sample tyre .Lhb ID 11'. d <br /> Sample ID ' � <br /> Date TimeGrab Camp A{alria TypeSire <br /> 4�/j5 y9 �f 5 x Mw- Remarks 30i0 <br /> /,s/g� rzfs x ML', _ 1 — — K336L- <br /> i{cnlarks t <br /> HetinquistKJ by(Signalwc) 1114DWS1-F)r 1�i' l iri h {1i�r +�atute) Ua1ie Time <br /> Hclincluished by(Signaturc) Date 'tile,` Iterrivc by(Signaturr) Date 'link <br /> Preservative: @-4"C 0-HCI Q-Na0H ®-Na2S203 5 -HNO3 ©-HrS 04 77 -01her ®-01her . <br /> SiteTimc: Dfiving'1'iu1c: !` 701211lom <br /> Start: SAW%: Total Iloury titan' Site Arrival: x2s <br /> Mileage: Approved By: , <br />