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GeoAnalytical Laboratorip, Inc. <br /> Lab Report # <br /> Regulatory El Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209)572-0900 <br /> Modesto.CA 95351 Fax: (209)572-0916 Regulator: <br /> Phone: ( } S 3 Z _ 1 <br /> Client: 5 CHAIN of Fax: <br /> T <br /> Adress: \PJ °, CUSTODY To: rz 14 in <br /> - zip C-1 <br /> Project ID T,a C �! 5 Q �— Lab Use Only <br /> (Print Name) - e U.MA I'll <br /> a <br /> Sampled By ti �►c c Aq kt <br /> (Print Name) „/ Container <br /> Sample p type Sample ID z E <br /> Date Time Grab Comp Matrix Type Site �� Remarksy , <br /> 24 I ds,MO' -01. <br /> z 12v X Z 2z . '. 't' <br /> 7 211q r 123:5 X <br /> 7/zl a' 1 5/o X S'w r i 2' , V t 4 alM_s4� <br /> .� w <br /> Remarks <br /> Relinquished by(Signature) A 7�3 gy J ! a�� eeiv y n 1 e D Ti <br /> Relinquished by(Signature) r(✓ /pat p I PF <br /> Re f <br /> ive by(Signature) Date Time <br /> . I <br /> Preservative: @-4°C 20-HCl @3 -Na0H ®-Na1S203 QQ -HNO3 ®-H2 04 7Q-Others ®-Others <br /> Site Time: Driving Time: Total Hours <br /> Start: Finish: Total Hours: Start: Site Arrival: x2= <br /> Mileage: Approved By: <br />