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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date Page _ _ of� <br /> _ = - <br /> - —_ ,. En�ironmenla Professionals <br /> �'W 1800 West March Lane, Suite A- Stockton, California-95207-(209)956-0264 <br /> Now r <br /> Project Manager <br /> Client &a 'e I` Bob MYVI)Z <br /> Tests Required <br /> o ���� Q 3 Phone Number )J <br /> _ _ 0Z0y )gy6 - 01 <br /> ;Z C Samplers: (Signature) Invoice: <br /> //GeoAudit ❑ <br /> Project Name M C f G �" ^ � /�y' /i / / Client <br /> 1 <br /> a r` <br /> Sample Type <br /> Sample Location Solid No. of Notes <br /> Number Description Date Time Water Air Conts./�� / <br /> p Comp. Grab. <br /> B �1 -39 1347ooA , Nw `{� 11-R r� :� s �` 1 x <br /> B5 -3 � �`Ilowl sw x i X <br /> w 3 ~ 7 w°i)! 5" Jk f 504) 17 <br /> wW <br /> �✓� _ -3 U <br /> inqu a y: ( i atureReceivedg re Daterrime ;"; <br /> 7 51d�c)q► I <br /> Relinquis d ign Rece' ed by: (Sig elure) �j�t7�! f I�C4? Q /(� D lerrim <br /> Reli uish d by: (SI ature) Received by MWWO aborslory for field analysis:(Signature) Date ime <br /> Dispatched by: (Signature) Daterrime Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> 5pq r I�pr <br /> Special Instructions: I hereby authorize the performance of the above Indicated work. <br /> r <br />