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t t I [ [ i i i t t [ l C l L [ i <br /> • 0501224 P�$�of�. • <br /> ��alogf�I yrs! - <br /> 1101,7tus Chain of Custody <br /> t209},1U2-41iF11,7az522- 227 <br /> I-mail:gcningicslterhzricst�ssbcglnlml.ocl Analysis Requested LaborBtary Name and Address; <br /> Prr'o�jeecctt.#: iclianviPr.0ject Mame: <br /> L y z tZ �t'°X•C`� <br /> O <br /> Sites Address- <br /> Purchase Order�# <br /> i~ EDF Report: LI Y J <br /> Sampted By:(print { girt name � o � � � Turnaround Ti S}Standard <br /> •" V O I <br /> C- �n`s��� .. -_. y S n r 1 day,-2 clay, 5 <br /> Data Tlme Sample I.D. MRemarks <br /> w � <br /> CUS-fWfSEAi.1NTACT? <br /> 7" Idsta <br /> Y 4 Mr <br /> A inqhi hed h (si�ratu�e) D te_ TirnQ: Fleceived by(signature) nate: Time; <br /> Relinquis ad by:•(signature) Data, Tree: Received b) (signature) Date: Time: <br /> Relinquished by;(signs um) Date: 'rime! Deceived by.:(s�gnata .) Date, Time: <br /> Y34 <br /> Please return cooler/ice chest to Geological Technics Inc. Rev.4d2MM <br /> 3 6:a .Zp <br />