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Geofogicaf Technics Inc. gQOb�IQ9 <br /> 27419' er Ppa <br /> Modesto,CaGfo 95357 <br /> (209)538-6424/fax#538 5852 <br /> Pro' t# Client/Pr jectN e <br /> S DT SDYi c y Laboratory Name&Address <br /> h� <br /> slyS <br /> i As 4 / <br /> mple ,(s" lure C� FK-,o - C) <br /> c V <br /> Date Sample I.D. Z /, Remarks: <br /> 5-7— 9 T—3 - 91 <br /> l <br /> s <br /> Relinquished i (signature) QatelTime R iv b ( ignature) PLEASE RETURN SAMPLE CONTAINERS Remarks: <br /> ,0r7kf e5 7- `pl Pr1 L 7L� ; if lA�/KGs` <br /> Relinquished by: (signature) Date/Time Received by: (signature) CC: 6) <br /> I Relinquished by: (signature) Date/Time Received by: (signa7e) <br />