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.4C t* t t t t t t t t t t t t t t t t t t <br /> Geological Audit Services, Inc. CHAIN OF CUSTODY RECORD <br /> Date —Page--2L—of 2 <br /> f p��@ l a� /� d,� Ca-,��b_,.,, , 1 PROJECT MANAGER <br /> Client -Fut c�1l�u�-tv/V &f , I <br /> PHONE NUMBER (�( <br /> ���� 334- 13j9Q <br /> PROJECT NAME SAMPLERS• ign ur;} <br /> CAfZb1 tJkC., A11E 9 &F � 7/�µr <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WA ER AIR SOLID NO. OF TESTS <br /> NUMBER DESCRIPTION Comp. Grab. CNTNRS REQUIRED <br /> COV-D 1561 ,� to f x c" �,, ► r°ti <br /> to � ; I <br /> i <br /> Relinquished by:(Signature) Received by:(Signature) Date/Time <br /> Relinquished by:(Signature) Received by:(Signature) �-, 1 <br /> Date/Time <br /> Relinquished by:(Signature) Received by Mobile Laboratory for field analysis: Date/Time <br /> (Signature) <br /> Dispatched by:(Signature) Date/Time eived for La oratoriby Date/Time <br /> P <� <br /> Method of Shipment: I1 hereby authorize the performance of the above in icated work. <br /> Special Instructions: <br /> SOURCE:Adapted from U.S.EPA. 1985 <br /> CCA-100 <br />