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G,oAnalytical Laboratories, Inc. <br /> IC_ Kansas Avl. <br /> Phone (209) 572-0900 <br /> N1& Califorrua 95=51 Fax =('209) 572-0916 — <br /> V <br /> CHAIN C. CUSTODYCient <br /> Address <br /> CC <br /> z;p i <br /> r <br /> J Y <br /> PRCUEC"v ID <br /> ANALYSIS <br /> SAMPLE .:Y•.(sgna:.:re) \- <br /> = • i <br /> RE.MAnKS <br /> Date i;m� rr J Sample ID <br /> X y <br /> J ' <br /> 4 <br /> Relincui w/t ` .ureji bate „--e , Received by(si9a /r/' - v�7ater T Mme <br /> Re6neu-wec:-y(scne;f--): Date �.re Received oy(signature): ✓ bate ime <br /> Reiineuisrw.,:y(signature_): Cate %,.,-- Received cy(signaturer / Date 7.-ne <br /> I <br /> Relinctris ec y(s:gnatur?): Cate --; Received 5y(signature): Date „rre <br /> i Relincius:.--c- �7.f(ssgnaturee): Date e Receivea by(signature): Date -^e <br /> i <br /> I � - <br /> Site i lrw: <br /> Driving i.,rne: <br /> Start: F nisn: Total Hours: Start: Fnisr <br /> Tct� -curs. ' <br /> Mileage _- Approved By <br /> { <br /> � 1 <br />