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GeoAal tical Laboratories, Inc. Lab Report# <br /> i Regulatory 4Yes ❑ No <br /> 1405 Kansas Avenue Phone: (209) 572-0900 <br /> Modesto,CA 95351 Fax: (209) 572-0916 Regulator: !911-711 /y <br /> Phone: ((-7/jo 63-0 <br /> Client: /'�' �f. r_A;()1 J2Q tV M 6,nl4-- `ZVC CHAIN OF CUSTODY Fax: qt <br /> Address: _'5 5/0 Stvt/!L -!�'_ K�GQ• To: G ctlGlC/ .�� <br /> City I . c". . Zip �As(e b c.1f4c — .S 0) <br /> Project ID �� •T/L' _ Lab Use Only <br /> (Print Name) �j <br /> A! <br /> Sampled By � a <br /> (Signature) Container u <br /> Sample type Lab ID# 2 <br /> Date Time Sample ID p„ <br /> Grnb Comp Matrix Type Size <br /> 'S �/� > � ��X6 Remarks Z1 7 7 Z_ l <br /> r x L 1 K.2t� � 3 / <br /> / 2�`? <br /> S � 7 <br /> Remarks <br /> �J> <br /> Relinquished by(Signature) _ Date Time Received by(Sign Dtime <br /> 'E/ <br /> Relinquished by(Signature) Date Tinm Received b ig ature) Date Time <br /> J <br /> Preservativ : 1Q 4°C Q2 -HCI ®-NaOH @-Na2S203 &HNO3 ©-H2S 04 7Q-Other &-Other <br /> Site Time: y� ® "'~ ,� Driving Tine ��,� �® y� h Total flours <br /> Start: j finish: Total Hours: ` /y �' Std' Site Arrival: x2= <br /> Mileage: �`� ? s� / c�cS Approved By: ' ' <br />