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i <br /> CHAIN OF CUSTOD RECORD <br /> Geological Audit Services , Date Page of Inc . �� <br /> v Environments Prolessiona/s <br /> 9��'� �� <br /> low <br /> �— 1903 West March Lane, Suite A- Slocklon. California-45207 - (209) 956.0264 <br /> r <br /> ClientS 5 Q;� $01 5 C 1-a 0"Y Project Manager <br /> 5 r Mur) Tests Required <br /> Phone Number <br /> (-�OCI)q�6-016 <br /> Samplers: (Signature) `�' Invoice: <br /> Project Name I')Y 55 _ D� B 0 i 5 V? i^-� y + GeoAuditCliertt <br /> LJ <br /> Sample Location Sample Type No of N !' <br /> Number Description Date Time Water Solid �� Notes <br /> p Comp. Grab. Air Conts. <br /> SIM- )�q 7-qq 14`0�, 3 <br /> -.,z 9-qy vv <br /> e rnquis a y: (Signature) acerlure Dat Ris <br /> Rol' qLAS : (Sig slurs Receive b Signalure) a e/Time <br /> ()J J7 I/ Q /V/ . <br /> Relinquished by: (Signature) Recer bile Labor at ry for field analysis: (Signature) Date/Tima <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: DalalTime <br /> Method of Shipment: Laboratory Name <br /> fll , l a <br /> Special Instructions: t hareb uthorize the performance of above indicated work. <br /> f 1 <br /> . L t <br />