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_ .�_ Geological Audit Services, Inc. CHAIN OF CUSTODY RECORD <br /> vF Date Page Ofmoo .�_ <br /> _ -" <br /> Client <br /> FA1 1AN PROJECT MANAGER <br /> PHONE NUMBER <br /> (IoV 5S7o - OZ� <br /> PROJECT NAME / SAMPLERS. Signaw P� <br /> CkPDI N A1-- AV r., <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WATER _ AIR SOLID NO. OF TESTS <br /> NUMBER DESCRIPTION Comp. Grab. CNTNRS REQUIRED <br /> Relinqui ed b (Si re) R e d b .( n t re Date/Time <br /> IL <br /> Relinquished by:(Signature) Received by:(Signature) Dale/Time . <br /> Relinquished by:(Signature) Received by Mobile Laboratory for field analysis: ✓ Oate/Time <br /> (Signature) I I <br /> Dispatched by:(Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: <br /> I hereby aufhOti2e the petl0fmatlCe of the above indicated work. <br /> Special Instructions: <br /> SOURCE Aoapted from U.S. EPA, 1985 <br /> CCA-100 <br />