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CHAIN OF CUST DY RECORD <br /> Geological Audit Services , Inc . o �•�$�Q4� page � z <br /> _ =�� EnYironmenla eo�Prnfessrlona�(s <br /> 1803 West March Lane. Suite A-Stockton. California•95207-(209)956-0264 <br /> t� <br /> Client �7rvt��f�a "L4 QaV � �o�t o Project Manager <br /> $0b Ma!!iTests Required <br /> Phone Number <br /> c00966-OA6`4 <br /> nature <br /> Samplers: Si <br /> p (Signature) <br /> ) Invoice: <br /> Project Name 6we�p ) It-f c,v� �% GeoAudit <br /> 1' Client p <br /> Sample Location Sample Type Solid No. of / <br /> Number Description Date Time Water / Notes <br /> Comp. Grab, Air Conts. / •�� l /; <br /> q" 20 X l X , <br /> /3-v I; qLl <br /> JY <br /> e inqurs a by: (Signature) ecerve y: (signature) yy .yy <br /> SrdNf�Oir¢ /t.�. Date/Time <br />' Relinquished by: (Signature) Received by: (Signature)) <br /> (M. L4tX� I �1,�6r-4 DatelTime <br /> Relinquished by: (Signature) <br /> Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> i <br /> j Dispatched by; (Signature) Date/Time Re d fo L.(Ab rat by: DatelTime <br /> Method of Shipment: Lab ratory Name <br /> t�` �OXiC <br /> Special Instructions: <br /> L hereby authorize the performance of the above indicntnd work. <br />