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Geofogica(Technks Inc. r <br /> 2741 Pjwr Rgad <br /> Modesto,Ca&fornia 95351 r <br /> (209)538-642417k#539-5852 <br /> FSiteAddress <br /> Client/P�oject Name ����^ Laboratory Name & Address <br /> 3 /L1 c Gr f,-i n Ip �� A r <br /> f ��S fs <br /> Sampled by: (signature) o <br /> ° Remarks: <br /> Date Sample I.D. z <br /> 01A <br /> Relin46ishedky, . (signature) Date/Time `Received by:-(signature) PLEASE RETURN SAMPLE CONTAINERS Remarks: <br /> //,w4 14 Y6V)Irt-' <br /> Relinquished by: (signature) Date,Time Received by: (signature) CC: <br /> a93o SSC <br /> Relinquished by: (signature) Date/Time Received by: (signature) <br /> y 1 (;llstodY Seat intact None Temp., relboa <br />