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— CHAIN OF CUS*Y RECO"AD <br /> Geological Audit Services , Inc . -7Date •�1��LI Page __ 1 of_ <br /> _ — -_ ErtYiror�menta Professrlonafs <br /> MEMAW <br /> 'r 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264 <br /> Client , r Project Manager <br /> G l,t/el�o �r3ur� �duf o rMo Rp� Mari Tests Required <br /> --� -- <br /> Phone Number <br /> (�6q) M-OAO <br /> Samplers: (Signature) / �/ /Invoice: <br /> l� l- O'x�a�/ GeoAudit <br /> Project Name V�we p � ^'+ %tc�'u�j'4' <br /> i Client ❑ <br /> Sample Location Sample Type No of <br /> Number Descri tion Date Time Waier Solid ����% Notes <br /> Comp. Grab. Air Conts. /�� <br /> )I/{ µw _ l -A /).- g-YLl �'�9�9�-1 `!-- W '7 <br /> R -K 10 X <br /> a M+k <br /> PI A f• ���t ------— 2= ° d X <br /> .,Ww S A /A- g--gLj <br />! Ilelinqurshed by: ,gnalure ecerve y: gnalure i yy rr <br /> Ilr+linquished by: (Signature) Received by: (Signaturg) �Pl� �� P.W J4 ilnl++�Ilrnr+ <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Uatefrime <br /> Dispatched by: (Signature) Date/Time Ro ' d fo L(kb rat by: <br /> Date rime <br /> Method of Shipment: Lab ratory Name <br /> iI 1r3xlt <br /> Special Instructions: I hereby authorize the perlormance of the above indicnled work. <br />