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ill <br /> CHAIN OF CUSTODY RE*D <br /> Geological Audit Services$ Inc. <br /> I 4$=A Date 7 /6 J Page of z11111— l <br /> lead New <br /> I <br /> PROJE TMANAGER <br /> Client �� (— <br /> awnNc NUMB=R <br /> PROJECT NAME / 71-:Xnalure) <br /> 1 $ANI�LF TSO= <br /> SAMPLE LOCATION I DATE TIME WATER AIR SOLID NO OF TESTS <br /> NUMBER DESCRIPTION Comp Grab CNTNRS REQUIRED <br /> 1 <br /> i <br /> rf 5 - Et 5r tJ <br /> SIX 7" 6 I x <br /> I3�C)c 8D/05z 7,1 ,I <br /> ! wft-i 0I 1 1 <br /> 7C C <br /> t66i,J-3 4ar 6&zwmu-,,,ee <br /> s <br /> Rerr qu�sned y (Signature) Received try {Signature) DatetTrme <br /> Relinquished by (Signature) ~Received Dy {Signature) Date/Time <br /> Relinquished by (Signature) Receives+ by Mobile Laboratory for held analysis DaterTime <br /> ;Signatwe) <br /> i <br /> Dispatched by{Signature) Date/Time !}Received to,LaDorwory by DatefTw. <br /> I <br /> hereby authorize the performance of,re above indicaled worn <br /> Method of Shipment <br /> t <br /> -- I <br /> Special instructions <br /> SOU <br /> RLE ACani rr Lis ECA '985 CCR M <br /> i <br />