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iaGeological Audit Services , Inc. CHAIN OF CUSTODY RECORD <br /> Date Page <br /> �r =w'= E1WA"1nenra/Prn&W1017a s <br /> V''� <br /> JEW ter 1605 Went March Lane Suite A-Stockton California-95207 (209)95s-026t <br /> Client CLD Ga-I-f'to Project Manager <br /> AIeenn <br /> 41277:7 <br /> Phone Number <br /> (' a9) q.;& -4 ZG <br /> :9m <br /> g . <br /> Project Name NO—eom L�-YA,,ej -2T S <br /> t:4 <br /> Sample Location Sample Type No of Tests <br /> Number Description Date Time comWater Air olid Containers ob Requiredp Grab <br /> . <br /> v` <br /> �G- � f�9 f ��i�c-sem S i -� ] • <br /> M <br /> KLI <br /> rn urs e (Q,ignalure oc ve y ( rg lure <br /> Date/Time <br /> Im is by ignatu e) Received by (Signature) t-9--lul.) <br /> DaterrimeRelinquished by (Signature) ved by ils Laboratoror held analyse ( DatelTime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTims <br /> Method of Shipment Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />