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Geologicaf Technics Inc. <br /> 27419ZOwXwd 9906000414- GEOL-TECH <br /> Modesto,California 95351 f , <br /> (209)538-5424/74X,#538-5852 <br /> Project# Client/f=t Name rAy Laboratory Name&Address <br /> t� f�•..� ��C�l J'7 � �,� <br /> si/ <br /> Sampled b r a �'l�n� + �f <br /> 0 <br /> Date Sample .D. z Remarks: <br /> (r -91 mAJ ' U <br /> l-9,Y 1 Q2w - <br /> 1 7- <br /> 4�iquis�Z(2,1 <br /> d b gnature) Date Time Received Yy nature) p Remarks: <br /> bye (si tore) Date/Time Received by: (signature) CC T3A <br /> Relinquisbed by: (signature) ate/Time Receiv d i ature) <br />