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v� s <br />P.O. Box 576981-6981 <br />Mal KJoberdanz & Associates Modesto, California 95357 Lab Report#_ <br />Environmental Services Phones (209) 577-8186 Regulatory [Yes pNo <br />Fax: (209) 577-8158 <br />1 —To Regu Tato r: <br />l,L <br />Phone: ( ). <br />Client.- CHAIN OF CUSTODY Fax: ( ) <br />Address: 121_' '5_ 4t*�, S i— To: <br />City — a 10 E5 ?",:> Zip 91 S_ / --- <br />Project ID „` <br />Sampled By <br />lgna <br />w. <br />Container <br />b cn <br />o d <br />o z <br />Q <br />z <br />Lab Use Only <br />co <br />Lab !D # lil� <br />(1 <br />Sam le ` <br />P Sana 1e ID <br />Date Time Grab Com Matrix p Type Size <br />' °'k A <br />Remarks <br />t Ij E <br />ti <br />— <br />.A. <br />-595 f <br />- <br />aE- <br />Remark <br />Relin y ure <br />Date <br />Ti <br />Receiv b igQature) <br />Dat Time <br />quished by , i ature) <br />Time <br />Received Signature) <br />Date Time <br />Preservafi e: <br />Site Time. <br />Start Finish. <br />Total Hours: <br />Driving Tim: <br />Start::. <br />Site Arrival: <br />Tctal Hours <br />� <br />X'_ <br />11 <br />a <br />