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I (00 70 V <br /> Page of i <br /> cieologccal7-eckiks lac. <br /> 11017th Street ` '="• `w'�"'°' <br /> �h�6 <br /> Modesto, Chain of Custody , <br /> 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: L-1 I C 4415 <br /> 0 to <br /> Site Address: w <br /> caPurchase Order# <br /> Remarks.: )' wca E <br /> 3 F EDF Report: 01es ❑ No <br /> Sampled By:(print and sign name) o 0 ; Turnaround Time: S=Standard <br /> �c�5L 4k A{;��►�y �,- o L x 1 day,2 day, 5 day <br /> Date Time Sa le I.D. z° Remarks <br /> i tri 11: Fc� "' I fir Ids <br /> l <br /> Reli q ished by:(signature) Date: Time: Re 'lved ((signature) Date: Time: <br /> Relinquished by: (s ture) Date: Time: RecQi ec by:(signature) Date: Time: <br /> Relinquished by: (signature) Date: Time: Received by: (signature) Date: Time: <br /> Please Return Ice Chests to Geological Technics Inc. Rev. 12/05 <br />