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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . � _ , - <br /> En�ironmen�a/Prolessiona/s Date_{ 6 = j Page of <br /> ONLAW 1803 West March Lene, Suite A -Stockton, California • 95207 •(209)956.0264 <br /> Client F4 j .;, E yl v wrr , Project Manager <br /> Tests Required <br /> Phone Number <br /> /11� <br /> Samplers: (Signature) `-// /./� �`&o"A <br /> nvoice: <br /> o ect Name c v 7 c I �.i�.l.t r, r ,,1 j <br /> <. •�/ / i / Client ❑ <br /> Sample Location Sample Type a - <br /> Date Time No. of <br /> Number Description Water Air Solid Conts. � / Notes <br /> Comp. Grab. <br /> r 1 <br /> hti <br /> qt l3 M o. <br /> T5 t_` 3 - <br /> -"W ` <br /> 'r C <br /> je mqurs a y: ( ignature) ecelve (SI nature) <br /> 7 � ,�/ /L' Do y/9/� `7r�/�//� Date/Time <br /> rLv <br /> Relinquished by: (Si lure) Received by (Signature) r�— <br /> �� `x Date/Time <br /> Relinquis d by: (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Dispatched by: (Signature) Dale/Time Received for Laboratory by: <br /> ` Date/Time <br /> r Method of Shipment: Laboratory Name // <br /> �r T�r �lirC <br /> Special Instructions: S q )')J <br /> I hereby authorize the performance of the above indicated work. <br /> 0 <br />