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CEO- GEO-MONITOR, Inc. <br /> P.O. BOX 1428 <br /> / 17152 DARWIN AVENUE <br /> MONITOR, HESPERIA, California 92345 1 <br /> INC. (619) 244-3481 <br /> CHAIN OF W&ODY RECORD <br /> PURVEYOR: I <br /> �� ANALYSIS REQUESTED <br /> PROJECT/CONTRACT/PO NO: REMARKS/SPECIAL INSTRUCTIONS <br /> I <br /> NAME OF SAMPLER: <br /> 1 <br /> LAB USE ONLY AMPLE <br /> LAB I.D. DATE TIME M A NUMBER 0 <br /> I.D. P. B TAINS S <br /> Mme/ o 7-t1 9! _.. <br /> I <br /> /e7 <br /> top <br /> I <br /> wp <br /> �E ;I <br /> i <br /> I <br /> RELINQUISHED BY(SIGN) DATE/TIME RECEIVED BY(SIGN) DATE/TIME <br /> ^ - R§CEIVED F9R'—ABORATORY j <br /> BY(SIGN)` DATE/TIME -� f / I <br /> r <br /> ❑ CLLQ(D AND INTACT OTHER PRESERVATIVE 11 YES El NO <br /> E] CtTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA: ❑ FED X ❑UFS ❑OTHER1124 HR 112 DAY 115 DAY [' qy <br /> SHIPPING ORDER NO.: <br />