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[ i [ [ t [ i [ [ i i f i t f <br /> GeoAnalytical Laboratories Inc. <br /> Lab Report# <br /> 1405 Kansas Avenue, Suite "A" Phone: (209)572-0900 Regulatory ❑ Yes LJ No CC: LJ Yes Ll No <br /> Modesto, CA 95351 Fax: (209)572-0916 Regulator: <br /> Client: Phone: (2j <br /> �;� /�� �A,� — s��zz �, CHAIN OF CUSTODY Fax: ( ) <br /> Address: Original To: <br /> City QZip <br /> Project ID <br /> (Print me g Lab Use Only <br /> Sampled By cls, `' .._._.... --....._..._._ . <br /> (Stgnat U �y <br /> Container <br /> Sample type <br /> Date Time Sample ID z i Lab ID# <br /> Grab Comp Matrix Type Size I a <br /> Remarks' <br /> v a 2 .t <br /> dox,ns <br /> — <br /> e A— <br /> z It s_ <br /> i I � <br /> i6z14Sze <br /> 3 <br /> Y .2q 5x22 <br /> G ! L2�f Srt 3 <br /> Remarks <br /> RKell i by S ature Date Time Received by(Signature) D to Time <br /> Re in uishcd ! <br /> q y(Signature) <br /> Date Time Received by(Signature) D,e <br /> Time <br /> Preservative <br /> Time <br /> Matrix <br /> Q 0-HCL © NaOH Q-Na2S203 © HNO3 0-H S 04 Q Other Drinking Water Waste Water Hazardous Waste(Water) @Soil/Solid <br /> Site Time: <br /> Start' Finish: Driving Time- <br /> Finish: Time Milea e <br /> Total Hours: g <br /> Start: Site Arrival: x2=Total: <br />