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.57 <br /> Geofogical Technics Inc. <br /> 2741 Yjmr7(pad 4 <br /> Modesto,Ca&jomia 95351 <br /> (209)538-6424/rfax#538-5852 <br /> Project# I Client/Project Name y laboratory Name& Address <br /> v c <br /> i <br /> Site Address S-. p C1 <br /> /`� <br /> Sampled by: (signature),- o <br /> . RC1 <br /> ��� . Jl - <br /> + -.6 - Remarks: <br /> Date Sample I.D. z <br /> f.F <br /> li <br /> �i <br /> • uk ,. <br /> RI A- <br /> Relinquished : (signature) pate/Time Received by: (signature) PLEASE RETURN SAMPLE CONTAINERS Remarks: <br /> Relinquished by: (signature) qa a/Time R eived by: s'gnature) ,CC: /I <br /> Relinquished by: (signature) Date/Time Recei'ed by: (signature) s <br /> hh y <br /> "ustody Seal Intact� Y No <br /> r,1lil.iJl)•V'' <br /> s ..�.«. conana� .. M ne Temp. <br />