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11017th Street � C� <br /> Modesto,CA Chaim of Custody- <br /> (i09)5224114 Fade 522-4227 <br /> E-mail:gti@geologieWtecWcsxom Analysis Req Laboratory Name and Address: <br /> Project#: Client/Project Name: <br /> r <br /> Site Address: m i✓! <br /> � � m Purchase Order#�C� L77a <br /> 0 C3 <br /> Remarks.: � E Q �� <br /> 3 i= EDF Report: ❑ Yes O-No <br /> Sampled By:(print and sag `narEe t a :� l� Turnaround Time = tandard <br /> `" 2 1 day, 2 day, 5 day <br /> .�.. 2..Z`� --. 0 'x C 4 <br /> Date Time Sample I.D. z { Remarks <br /> 2-2 t 3 3 qC <br /> V, 44 <br /> R ' q ish d by: (s, ature) Da e: Time: Received by,1(signature 7 Date: Time: <br /> Re inquishe y. (signature) Date: Time: Receiv d by: (signature)L/f Dat6: Time <br /> Relinquished by: (signature) Date: Time: received by: (signature) Date: Time: <br /> Please return cooler/ice chest to Geological Technics Inc. Rev.12103 <br />