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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc. Date 12 - 1 -23 - Page Page of z <br /> - =� En�ironmentalProfessbna,Fs <br /> r <br /> W:07 1803 West March Lane,Suite A-Stockton,California-95207-(209)958-0284 <br /> client C 9 1 d ro Project Manager <br /> h �5 M a ru e I Tests Required <br /> 770b 1111r? <br /> Phone Number <br /> coq 15 6 -o.2 <br /> Samplers: (Signature) Invoice: <br /> Project Name (-,114 I /eoAudit <br /> ro N 5 Mavj�� �� Client ❑ <br /> Sample Location <br /> Sample Type No. of /;' <br /> Number Description Date Time Water Air Solid Conts. '�� ' Notes <br /> Comp. Grab. ' <br /> TP /II-36 -Q Fxcgvg1;pV\ wm-93 16.00X -� <br /> .�-1902 - l <br /> 5P— 1 5TocKp;1, 0 I X X .71 <br /> 5P-3 5W 13:40 x l X K <br /> 5 - 1 50,11h wql 11-7013 13: oa ( X � Sr <br /> E - I FasT wq 11 f 3:w4 I X ro <br /> w - 1 1 W•'57 vv I I ) 5;30 <br /> e inquished by: (Signature) ecerve y: ignature Date/Time <br /> 24A,,4 �hc7 �1 5Tartc�a4T-A X. <br /> Relinquished b � ��\ 9 <br /> q y: (Signature) Received b (Signature)Y� ( 9 ) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> A l �a <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />