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Geological Technics Inc. �. <br /> 2741 JUwr dyad <br /> Moduto,Cofifornia 95351 <br /> (209)538-64241Yaq#538.5852 <br /> Project# Client/Project Name Laboratory Name& Address <br /> Sl- 3 1 I'Vc G,, (Gy h.,, e �� !f '' Z �S <br /> I <br /> Site Address u. S,6-s- ���'`�^ A—G� V <br /> Sampled by: (signature} o �- <br /> Date Sample I.D. z <br /> Remarks: <br /> --1 -moi" lr� -/ Z • 5- G <br /> A 7 <br /> -- t <br /> 2,5 <br /> - _ X <br /> �7 <br /> Relii►quished si nature) D�te/Time R/e eived by: (signs re}. PLEASE RETURN SAMPLE CONTAINERS Remarks: <br /> Re)i quishedy: (sign ture) Date/Time eceived by: Si( ature) CC: <br /> Relinquished by:'(signature) Date/Time Received by: (signature) <br /> I <br />