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4:� t t <br /> =41 Lzl--'- Geological Audit Services Inc. CHAIN OF CUSTODY RECORD <br /> Date Z 2— Page of <br /> tttea>r <br /> _��'� �u� �� PROJECT MANAGER <br /> Client �AIW'`' <br /> �.�,^ <br /> PHONE NUMBER <br /> PROJECT NAME L <br /> SAMP <br /> n <br /> CALNA <br /> SAMPLE Tv E <br /> SAMPLE LOCATION DATE TIME _ WA T cR AIR S NO.OF TESTS <br /> NUMBER DESCRIPTION Comp. Grab CNTNRS REQUIRED <br /> -Zo - 1 -viG PLG- 1 2 z �( 1 1 tf c0 <br /> 1 -zi- r r► 1/2,7 <br /> �( 1 <br /> �z 'C / <br /> I-z2- r Ir ► L Y / <br /> Relinq ed; y:(Signa ► eceived by:(Signature) <br /> �� ��• � � Date/Time J <br /> Relinquished by:(Signature) Received by:(Signature) Dale/Time <br /> -Fre ingwshed by.(Signature) Received by Mobile Laboratory for held analysts Date/Time <br /> ISignalur-e) <br /> Dispatched by:(Signature) Date/Time Received for story py: Date/Ti-me— <br /> Method of Shipment: I hereby authorize the performance of the above Indicated work. <br /> Special Instructions: •. <br /> SOURCE Aoapled Itom U.S EPA. 1985 _' <br />