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CeoAnalyricafTaiLllepo <br /> Re ulato :11 Yes ❑ No CC: L3 Yes o <br /> g ry <br /> 1405 Kansas Avenue, Suite "A" Phone (209)572-0900 <br /> Modesto,CA 95351 Fax (209)572-0916 Regulator: <br /> - Phone: - <br /> ft� AIN OF CUSTODY { � ) <br /> Client Fax: <br /> CH � z <br /> Address _ /Cir' - Original To <br /> City ' •- / zip <br /> C �f 3� <br /> Project 1D "L/' c_ ��vr-k� _ Lab Use Only <br /> (Print mei � <br /> Sampled By - /// E <br /> l M1f401 <br /> r <br /> (Stgn ) Container <br /> Sample typez Lab ID# <br /> Date Time Sample ID a <br /> Grab Comp Matrix Type Size <br /> G3 / ti _'� y " �� ✓ Remarks <br /> o \ <br /> i <br /> Remarks <br /> Reha ed V n e} Date Time Recei e y(Sign t ) Da Time <br /> mquis diy(Signature} Date Time Rece a ignature) Date Time <br /> Preservative Matrix <br /> 0-4°C Q-HCL Q-NaOH Q-Na2S203 Q-HNO3 Q-H2 S O4 ©-Other (MiDrinking Water aWaste Water 4WHazardous Waste(Water) QSoiVSolid <br /> Site Time Driving Time Time Mileage <br /> Start Finish Total Hours Start Site Arrival x2=Total 1 <br /> Turnaround Time ❑Standard ❑Silver Rush ❑Gold Rush 1]Platinum Rush 00ther Approved By <br />