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n Incab Report# � 634 - lq <br /> GeoA alytical Laboratories, c. <br /> Regulatory DYes 13 No CC: EMS Mo <br /> 1405 Kansas Avenue Phone: (209)572-0900 <br /> Modesto, CA 95351 Fax: (209)572-0916 Regulator: <br /> Phone: <br /> Client k11 a k4� 1-'a tis CHAIN OF CUSTODY Fax: <br /> Address S7 6oI S I ®EDF 13EDT Original To: <br /> City Zip ® FIELD LOGS C.0 To: <br /> Protect ID t on Lab Use Only <br /> (Print Name) <br /> Sampled By c.h"'- h <br /> nature tt, <br /> (S►g Container ^ T <br /> Sampte type z° <br /> Date Time Sample ID ,- <br /> Grab Comp Matri Sue p Rema' <br /> Q, ✓ W <br /> Inw - <br /> W w wl 1 x <br /> iN - X X y <br /> 3°o 3 <br /> Remarks <br /> Relinquished by(Signature) Date Time Receiv by( nat Date Time <br /> 1 —3y <br /> Ps <br /> Relinquished by(Signature) Date Time Recei dA <br /> (Signature) Date Time <br /> Preservative Matnx <br /> O4°C9HC10Na0H0 Na2Sz03©-HNO3 O- S a a-Other g ® (Water)H 0 her � Drinking Water Waste Water Hazardous Waste Water SotllSolld <br /> 4 Pump Truck_- Time Mileage <br /> Sailers�55 Gallon Drums <br /> Approved By: <br /> Turnaround Time ❑siardard QSanr Rush Gold Rush Platinum Rush QOther <br />