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i ■� ■gypp ■� �_ � � j .100 M <br /> jeologtcal7'e iS g6ZG Fl}7 1' `j 1pu�� Page t of <br /> 11017th street (�'� Chalin of Custody <br /> Modesto,CA <br /> (209)522-4119 Fax 522-4227 <br /> E-mail:gti@geologicaltechnics.com Analysis Requested Laboratory Name and Address: <br /> Project#: Client/Project Name: Me, <br /> Llas--ai <br /> Site Address: `r tr0 yr T �!. m K _--- <br /> f lS% •(—` � A Purchase Order# O <br /> Global ID No.: S a <br /> EDF Report: ❑ Yes 00 <br /> SampledBy: (print and sign name o n � � Turnaround Time: S=Standard <br /> v 1 day, 2 day, 5 day • <br /> Date Time Field I.D. 1 Sample I.D. z Remarks <br /> 3 ^ S ?C 21 O[ C PA <br /> J <br /> 3 u IlHa <br /> e —r <br /> -?] ?o 6 PF k <br /> U ' <br /> ES S-3 <br /> Fv <br /> Relinquished by: (signature) Dote: Time: Received by: (signature) Date: Time: <br /> i _ice 1-4 , J '.3— --,, <br /> Reiinqui hed by: (signature) 1 Date: Time: Received by: (signature) Date: Time: <br /> Relinquished by: (signature) Date: Time: Received by: si naatyurr 1 Date: <br /> Please return cooler/ice chest to Geological Technics Inc. Rev.4/2004 <br /> 4 <br />