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CEO- GEO-MONITOR, Inc. � <br /> P.O. BOX 1428 4 <br /> /� 17152 DARWIN AVENUE <br /> MONITOR, HESPERIA, Callfomla 92345 ' <br /> � INC. (619) 244-3481 <br /> I' CHAIN OF CUSTODY RECORD <br /> + PURVEYOR <br /> ANALYSIS REQUESTED <br /> r- <br /> PRo,1ECTiCONTRACTlPo No REMARKS/SPECIAL INSTRUCTIONS <br /> C t r ♦ r"i ♦ r� r <br /> 1 <br /> NAME OF SAMPLER <br /> LAB USE ON-LY' <br /> SAMPLE DATE C G NUOF <br /> r <br /> LAB 10 1 D, TIME P n CON / <br /> 9 TAINEHS <br /> +lam 7:C /' s <br /> i <br /> s <br /> 1 ` <br /> i <br /> �h <br /> i <br /> I � <br /> RELINQUISHED BY(SIGN) DATEnIME <br /> MECEIVED11DATErrIME RECEIVED FOR LABORATORY <br /> BY(SIGN) pATE/TEME <br /> RECEIVED <br /> ❑ COLD ANDINTACT OTHER PRESERVATIVE ❑ YES ❑ No <br /> ❑ OTHER <br /> r <br /> L—HIP—PEDWA ❑FED X ❑UPS=OOT=HeR TURN AROUND TIME <br /> SHIPPING ORDER NO ❑ 24 HR Cl 2 DAY ❑ 5 DAY 11 10 DAY <br />