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eoiogical Technics Inc. <br />1101 7th Street <br />Modesto, CA 95354 <br />(209) 522-4119 / fax (209) 522-4227 <br />geologicaltechnicsasbcglobalnet <br /> <br />Project # ....... - Client/Project Name 1 No. of Containers T <br />. ,,, <br />--:.., '-- rt:r <br />' <br />k <br />Laboratory Nartte & Address <br />A <br />, . <br />Remarks: <br />Site Address , _ ..-„. : :1t ,,. - , <br />,., Sampled by (signature) <br />Date Sample 1.D. <br />i <br />III <br />111 <br />___________UI II II <br />111 III 11 <br />RI I. <br />mu uU <br />Relit> 'shed by: (signature) <br />. iti <br />Date/Time Received by: -(signature) PLEASE RETURN SAMPLE CONTAINERS Remarks: <br />.... a Y Relinquished by: (signature) Date/Time. Received byjSign— attire) CC: <br />Relinquished by: (signature) Date/Time <br />I _...,.,......_ <br />Received by: (signature) <br />. _....