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t� t.. c <br /> CHAIN OF CUSTO RECO"ID <br /> .-. Geological Aurilt Servic;es3 Inc . Date 2,_14- gPage � of <br /> ME17w=menta Pro%s: i q.?1s <br /> t:W 1803 West March Lane, Suite A-Stockton,California-95207-(209)956-0264 <br /> r <br /> Client Project Manager <br /> +wtl�� L.dKd pet►alo Tests Required <br /> Phone Number <br /> 2-oq g56- 0,z6t-1 <br /> Samplers: (Signature) '0 Invoice: <br /> Pr°jectName ��,y.lal� )4 ► yYkr?4u•4w_1 �y" / `eoALt i <br /> / Client ❑ <br /> Sample Type '%-f' <br /> Sample Location <br /> Number Descri tion Date Time Water Solid No. °t ;'-`h ` Notes <br /> p Com Grab- I Air Cants. j 4, %' <br /> �w- IH /X-z -q ;.-)q-qq <br /> — r_ AY <br /> T 0Y <br /> i <br /> Relinquished by: (Signature)tcerve y: r ure Date/Time <br /> A04 V1, <br /> R u shed by: (Signature) ed by: (Signature) j Date/Time <br /> Relinquished by: (Signature) Received y Mo a Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) DatetTime Received for Laboratory by: Dale/Time <br /> Method of Shipment: L <br /> /a <br /> `boratory Name <br /> Veo Aq4 7'C <br /> Special Instructions: I hereby au horize the performance of the above indicated wotk. <br />