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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date �31 � Page of <br /> g �- <br /> --� En�imnmenta Professionals <br /> 1803 West March Lane,Suite A-Stockton.California 95207 (209)966-0264 <br /> 14 V- aP�hon <br /> Manager Tests Required <br /> Client a� (�p`l'y �l i arl <br /> 5 10 3 umber <br /> F. o- °x -o <br /> S10C14)bh G1r') q 7-D5� Samplers: (Signature) Invoice: <br /> Client <br /> Project Name Mid` Lay � ✓�v"`'t'` ���"'�'�'"'-' � / . � <br /> Sample Type No, of ,7 / /./� Notes <br /> Sample Location Date Time Water Solid <br /> Air Conts. <br /> Number Description Comp. Grab. <br /> 1-31-q3 x <br /> N — 1 4- <br /> w-� <br /> Dela rim <br /> P'•� e <br /> ign re Sd"�1 9��i7- C) <br /> e mqu�s a y: ignalur I <br /> p1tpSP lh4p DAIQ C ate/Time <br /> Ral qui : (Signatu ) R calved by: (Signature) � � <br /> DatelTime <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> Rec Iv d for L boratory b Dale/Time <br /> DatelTime <br /> Dispatched by: (Signature) a. <br /> Laboratory Name <br /> Method of Shipment: 5 Vrt r <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: <br /> b 1 tJ l <br />