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( [ [ [ [ t f f [ ( f ( t [ [ f l t <br /> =� Geological Audit Services, Inc. CH IN F CUSTODY <br /> �Page <br /> RECORO <br /> "V= Date Z- of Z <br /> f• <br /> Client � � Q� G�rD� PROD CT MANAG <br /> ----------------- <br /> PHONENUMBER <br /> PROJECT NAME /� SAMPLERS. (Signature) <br /> VA-/ICAVl,'O^ Avg <br /> SAMPLE i vPE <br /> NUMBER SAMPLE LOCATION DATE TIME %VATcR AIR SOLID NO. OF <br /> DESCRIPTION TESTS <br /> I Comp. Grab. CNTNRS REQUIRED------------ <br /> / <br /> 9 � <br /> i <br /> Reli fsA "gnature) Received by:(Signature) <br /> Date/Time <br /> Relinquished by:(Signature) Received by:(Signature) T <br /> Date// <br /> Time <br /> Relinquished by:(Signature) Received by Moble Laboratory for field analysis <br /> (Signature) Date/Time <br /> Dispatched by:(Signature) Date/Time R <br /> for Laboratory by <br /> Date/Time <br /> Method of Shipment: 6 —1 Ir--�0 <br /> I hereby authorize the performance Of the above indicated work. <br /> Special Instructions: <br /> SOURCE:Aoaofea from U.S. EPA,1985 <br />