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---�-- <br /> Page of <br /> TT''ole ccal�'e�knccs leu. �4-r �� _ <br /> L <br /> 11017th Street F"l 1V Chain of Custody <br /> (209)522-4119 Fax 522-4227 <br /> E-mail geologicaltechzucs@sbeglobal net Analysis Requested Laboratory Name and Address <br /> Protect# Client/Proleci Name <br /> 507:� y�4 <br /> Site Address v; <br /> Purchase Order# <br /> Global ID No 3-701 3 4'-T <br /> -FO , D&-1 c ca EDF Report Q-Yes ❑ No <br /> Sampled By (print and sign name) o L1 , Turnaround Time S=Standard <br /> ion o4 o �G 04D o � � � � 1 day, 2 day, 5 day <br /> m , <br /> Dato ERemarks <br /> 1e Nrme Field 1 D Sample I D 0 3 E_ <br /> !� r P G <br /> Reiin�uished by signatur Date, Time Received by (signature), Date Time <br /> i <br /> F( quished by (sdnature) Date Time fRe elved by (siggatbre) Date' f Time � <br /> Relinquished by (sig6fiture) Date` Time Received by (signature) Date Time 1 <br /> Please return cooler/ice chest to Geological Technics Inc. Rev 412004 <br />