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r r r r r r r I r r r r r 1 r r r r r <br /> Report ort# <br /> GeoAnalytical Laboratories, Inc. P <br /> Regulatory ❑Yes ❑ No CC: ❑Yes ❑ No <br /> 1405 Kansas Avenue, Suite "A" Phone: (209)572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> / Phone: (, ) 5 22 I'l T4 <br /> Client: sD c . CHAIN OF CUSTODY Fax: <br /> Address: Nne 2 Original To: <br /> CityZip <br /> Project ID & 5 V Lab Use Only <br /> ��y ,rte tr <br /> Sampled By <br /> [(�Pr <br /> n �` lL.. K d ..r .,. 4D-Signature) o y <br /> �G Container U <br /> Sample type Q' r <br /> a� <br /> Date Time Sample ID z Lab ID# <br /> Grab Comp Matrix '1 pe Size <br /> G U 6- 7 ' <br /> � Z Remarks 3i'ZOq <br /> 3lzog <br /> t <br /> i <br /> Remarks <br /> Relinquis y.(S' n re) Date Time Received by(Signature) to Time <br /> a f o0 02=s' <br /> Relinquished b (Signature Date Time Z5 z me Received by(Signature) Date Time <br /> Preservative Matrix <br /> Q-4°C 0-HCL Q-NaOH Q-Na2SZ03 0-HNO3 .0-H2S 04 Q-Other Drinking Water taWaste Water®Hazardous Waste(Water) ©S000 id <br /> Site Time: <br /> Ste: Driving Time: Time Mileage <br /> Finish: Total Hours: Start: Site Arrival: x2=Total: <br />