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��\� ! <br /> _ Lab Report# d _01&_ <br /> r <br /> GeoAnalytical Labors Dries, Inc. Regulatory Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209) 572-0900 Regulator: _Cf <br /> Modesto, CA 95351 Fax: (209) 572-0916 Cl <br /> Phone: (Zd'i) <br /> Client: ' F <br /> CHAIN OF CUSTODY Fax: Gds- ) <br /> �� �� <br /> Address: <br /> �� &-,K To: <br /> City > �_ CA ' Zipi <br /> -/� Lab Use Only <br /> Project ID <br /> W <br /> (Print Name) <br /> Sampled By " <br /> {Signature) Container _� ��' �, <br /> Lab 1D# a <br /> Sample type Sample ID <br /> Date Time Grab Coinp Matrix ,type SILL <br /> 7 }� Remartcs �� <br /> r2-to-r�, fp: lel, uO — <br /> ui3 111- <br /> /0.t', V13-+ <br /> 11- <br /> 3-} ) <br /> Remarks <br /> ` i L\ is <br /> )�• L Time <br /> Relinquished by(Signature) Date fintc I ce' c (Si Ana }�� � `1-T, �,`t� <br /> :: <br /> Dale Tillie eccived by(Sign: ire) Date Time <br /> Relinquished by(Signature) <br /> Preservative: 10-4°C 02 -HCI Q-NaOH ®-Na2S20a 0-HNO3 ©-H2S 04 (2)-Other ®-Other <br /> Driving l"into: foto! Hours <br /> Site'Titne: <br /> Start: Site Arrival. x2- <br /> Start: Finish: 'total Hours: <br /> Mileage: Approved By: <br />