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4Ct,� < < I. < < t t t t t t c c t t t t t <br /> Geological Audit Services, Inc. CHAIN OF CUSTODY RECORD <br /> �v Date `d Page__Z of .2— <br /> v- <br /> Client �A-L/�Il� VIJMC3q �tA.�K,�� S�C.�`�Dll� <br /> PROJECT MANAGER <br /> &o b ,fit <br /> PHONE NUMBER <br /> PROJECT NAME SAMPLERS: ( iona re <br /> CSD I MAL, 4Ve 18��u c� of ��zx.K-atj <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WATER AIR SOLID NO. OF TESTS <br /> NUMBER DESCRIPTION CNTNRS <br /> Comp, Grab. REQUIRED <br /> MA N044 E'v� I to � X 1 Tp�-�-> Tp q P <br /> GAIzD_z 30 )I t o i TR. �- <br /> X 1 gipl Cry/1 I�r,�Pb <br /> CA�-D-3 5a� !► lo� � X 1 <br /> CAD_4 7o i <br /> C4R.P-5 Qa/ <br /> 1 <br /> Relinquished by:(Signature) Received by:(Signature) <br /> �j Ty Date/Time <br /> Relinquished b (Signature) 2 wk, r ' , I <br /> q Y'( 9 1 Received by:(Signature) <br /> Date/Time <br /> Relinquished by:(Signature) Received by Mobile Laboratory for Feld analysis: <br /> (Signature) Date/Time <br /> Dispatched by:(Signature) Date/Time ec ved for Labor y by: <br /> at /Time <br /> Method of Shipment: <br /> 1 hereby authorize the performance of the above in iced wort( <br /> Special Instructions: <br /> SOURCE:Adapted Irom U.S.EPA. 1985 <br /> CCR-100 <br />