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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc. Date low (-Q2Page --Lof Z <br /> A97V11V17Menta1P1V1eSS1017819 <br /> 1803 West March Lane, Suite A-Stockton, California-95207 (209)958-0264 <br /> sY <br /> Client <br /> ��� ' _ �,�'e� ���� Project Mana er Tests Required <br /> pX v 3 Phone Number <br /> sTa rCAt Zv Z 001 Si><.s� -OZ� <br /> Samplers (Signature) � Invoice <br /> ��� �h�-J_ GeoAudR <br /> ❑ <br /> Project Name is ( / ,L�'"` �A , Client <br /> Sample Type !" <br /> Sample Location Date Time Water Air <br /> Solid Coonts �4 Notes <br /> Number Description Comp Grab <br /> 5 <br /> 5 P <br /> 5P <br /> Zq i e y ignature ecewe y ignature Date rime <br /> . f, T'Gished by (Signature) Received by (Signature) J DateMme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DateJTime <br /> Dispatched by (Signature) Datele Re i d f r Labor ry by DatalTime <br /> Tim <br /> 11 <br /> Method of Shipment Vaboratoly Name <br /> Special Instructions i hereby authorI the performance of the above indicated work <br />