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1-40 <br /> c7edogical Technics Inc. <br /> 1101 7th Street <br /> Modesto,CA 95354 <br /> (209)522-4119/fax(209)522-4227 <br /> geelogicaltachnics@sbcglobal.net <br /> ............ <br /> Project# Client/Project Name <br /> Laboratory Name&Address <br /> Site Address <br /> c. <br /> Q <br /> U k <br /> Sampled by: (signature) <br /> C <br /> Date Sample I.D. Remarks: <br /> F, <br /> U ti <br /> j <br /> :Sk�ALI <br /> Relinquished,by: (signature) Date/TimT Received by: (signature) PLEASE RETURN SAMPLE CONTAINERS Remarks: <br /> Relinquished by: (signature) Date/Time Received by: (signature) CC. <br /> "d <br /> Relinquished by:(signature) Date/Time Received by: (signature) <br />