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�-- -� GeoAnalytical Laborato s, Inc. <br /> Lab Report # <br /> Regulatory ❑Yes © No <br /> a& erg I405 Kansas Avenue Phone: (209)572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> Phone: (2 cR <br /> Client: C CHAIN Of Fax: (zo5 ) <br /> Adr6ss: 1 V�' o w CUSTODY To: <br /> aY 5C Zip 9S R 7D <br /> Project ID j l ACV . [p d S/b r Lab Use Only <br /> (Prin Name) c� <br /> Sampled By —{t l�f-, <br /> (Print Name) Container o Q ' X <br /> V <br /> o Y SabID°#€ y <br /> Sample type <br /> Sample ID z ;. <br /> Date Time Grab Comp Matrix Type Sixe Remarks <br /> +SI Y J DSS a< S►n! J 5.S ' 1 <br /> Cr t 160 5w S <br /> f <br /> Remarks <br /> Relinquished by(Signature) at Time Rece ve <br /> 7 rS q F, M <br /> Relinquished by(Signature) Date Time Received by(Signature) Date Time <br /> Preservative: 1Q-4°C &HCl 03 -NaOH ®-Na2S2O3 Q5 -HNO3 0-H2S 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 />