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CHAIN OF CUSTODYL _CORD <br /> Geological Audi <br /> t Services , Inc. pie a •��- q�pa 3 3 <br /> —_ EnVironmenta/Professiona/s 9e of <br /> tib <br /> MW 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264 <br /> r . <br /> Client MProiectManager <br /> 0 Tests Required <br /> Phone Number <br /> 'J I-) q-c& `o Z �, 4 <br /> n Samplers: (Signature) Invoice: <br /> Project Name PU( � GeoAudit <br /> IIII i <br /> Client ❑ <br /> Sample Location Sample Type V <br /> Number Description Date Time Water Air Solid Cont Notes <br /> Comp. Grab. <br /> 5' f o S-►r-5 s �' <br /> e i enature ecery ign tur j <br /> ate/T,me _\ <br /> Rel, quished by: (Signatur Recei ignature 9,-3 , J S <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratob <br /> ry y:: Date/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />