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I .O. Box 576981-6981 <br /> M.J. Kloberdanz <br /> & ASSOCIateS iVlodesto, California 95357 U4c5— n <br /> Environmental Services Phone: (209) 577-8186 Lab Report !# <br /> Regulatory ❑Yes ❑No <br /> Falx: (209) 577-8158 <br /> Regulator: <br /> Phone: ( ). <br /> Clierti: C�L) �e4A !' s CHAIN OF CUSTODY Fax: ( ) <br /> Address: To. <br /> City zip _ --- - — --- - -- -- - <br /> Project ID _ Lab Use Only <br /> t.Pri <br /> Sampled By --- -- <br /> (Sign Container C Q Lab ID# <br /> C. <br /> Sample ty p <br /> DateTime Sam1le II) ` ' <br /> 0. <br /> Grab Comp Matrix <br /> .Z3 r.� 0 f .—S U 1 Remarks V 41 <br /> _ <br /> A <br /> L.90135 <br /> x/35 <br /> .S v r3 - z < tom/y3 7' <br /> it 3 g <br /> U / ' ! <br /> J d- - J / 9` L <br /> Z10 U D r r ^ v ` G 2 <br /> �yyy <br /> 02 <br /> R Gniurks <br /> R e Si at } Date Time R,_c ved b gnatre) Date me <br /> A, � 5 s44-) (1013 <br /> Rsl nq hed by(Sigrature) Date Time Rece-ve by(Signature) Uate T!me <br /> Preservative- <br /> Site Time Driving Tim. T.tariours <br /> Inlsh• lntat HOU:: — Start:: site_lnrval <br />