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Lab Kepu.L ,f _� <br /> GeoAnalytical Laboratories, Inc. <br /> Phone(209) 572-0900 <br /> 1405 Kansas Avenue FAX(209)572-0916 $/3 3 — 025- <br /> Modesto,CA 95351 phone: <br /> Fax: It Ai <br /> U� <br /> CHAIN OF CUSTODY To: <br /> Client: <br /> Address: <br /> 4C L, Zip /� t <br /> Project ID <br /> (Printt Name) �>(.r� �e �(7 Lab ID# <br /> Container <br /> Sampled By (Signature) p �'�t ��� <br /> 0 <br /> Sample type Sample ID Type Siu z l 03 <br /> Date Time c„i, C...„i, nt: r. L X x X X JJ -10353 <br /> Ao <br /> /J.rl65 -C "Noce ` <br /> � .J <br /> Remarks N V/Je S S C /S <br /> t X <br /> Cu Date Tinre <br /> �yv <br /> C / /- S / J •e���i Cimc cc d by (Signatt re) <br /> ANN. k/e, Date ,Lt�C�� 6� Time <br /> 'i nature) /f /'' ��;5 Date <br /> Relinquish - g 3—�jReceived by (Signature) <br /> Date Time <br /> Relinquished by ignalure) (Signature) Date Time <br /> Date Time Received At Laboratory by (, 6 <br /> total Hours <br /> Relinquished by (Signature) 5 <br /> Driving Tit eQ� Site Arrival' x2= <br /> Start: <br /> TTotal Hours: <br /> Site ime: r <br /> �DBa Finish: <br /> Start: - <br /> �[ Z � Approved By <br /> Mileage l\ <br />