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[ i C [ [ [ ( C ' i i - [ f C t [ E . i i <br /> Aa <br /> � CHAIN OF CUSTO� , RECORD <br /> Geological Audit Services Inc . D�ear9—= � EnVironmenta Professionals ' 3 Page -- of Z3_._ <br /> 00641V 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264 <br /> Client Pro' ct Manager <br /> Tests Required <br /> Phone Number <br /> 2a'7 -o ;_>&- <br /> - <br /> amplers: (Signature) Invoice: <br /> Project Name �- GeoAudit ❑ <br /> Client <br /> Sample Location Sample Type , I <br /> p Date Time Water Solid No. of �� <br /> Number Description Air Conts. �D Notes <br /> Comp. Grab. <br /> I6 9 I <br /> e i dure ecerve y: i nature <br /> ate ime <br /> Relinquished by: (Signature) <br /> Received by: (Signature) <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) <br /> Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: <br /> Date/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: <br /> I hereby authorize the performance of the above indicated work. <br />