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11017th Street <br /> Modesto,CA Chain of Custofly } <br /> _ <br /> (209)522-4119 Fax 522-4227 I <br /> E-mail:gti@geotogicaitechnies.com Analysis Requested Laboratory Name an cess: <br /> Project#: Ciient/Project Name. -- 0�4 s <br /> `m <br /> ICS S, c <br /> ra c t Q_SL-Q� tj X C t�C nh <br /> Site Address. ; <br /> , Purchase Ordcer# �- <br /> Remarks.: E2 m � 0z) Q 1 <br /> FDF Report: ❑ Yes 14% <br /> Sampled By: (print and snr�nadq-�,— o aTurnaround Time: S=Standard <br /> C. 2 4 i 1 day d 5 clay <br /> Date Time Sample I.D. z { Remarks <br /> L=z5 t� 15-1 Q _ j 13 ` 5 <br /> VJ C. <br /> r-wS Q r'1 L' �_�w •o <br /> i���•� ► S SP -Q- 1 S r c <br /> Q <br /> Rep is d by: (s gnature) Q te: !! Time: Recei red by: (�j na gra) Date: Time: <br /> Relinquished by: (signature) Date: Time: Received by: (signature) A G' J Date: Ti <br /> Relinquished by: (signature) Date: Time: Received by: (signature) lJ te: Time: <br /> Please return cooler/ice chest to Geological Technics Inc. Rev. 12/03 <br /> i <br />