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CHAIN OF CUSTO ECORD <br /> Geological Audit Services , Inc . owe -g-g Page � of <br /> ..�.r <br /> EnYiron1n6V7 ?Professionals <br /> 1803 West March Lane, Suite A- Stockton, California-95207-(209)956-0264 <br /> Client ,$qh [� Of Project Manager <br /> aanager <br /> r . o <br /> r Tests Required <br /> P- 0. Box )Z Phbne Number <br /> ;.oq q5' 6 - 0-7-69 <br /> 57oc�7e�s GI`1 QS�o Samplers: (Signature) Invoice: <br /> Project Name lil/' 4y ❑ <br /> �5 7 r h GeoAudit <br /> f L �� / <br /> y Client <br /> ay /Sample Location Sample Type <br /> Number Description Date Time Water Solid No. of �,�f / / ' Notes <br /> Comp. Grab. Air Conts. <br /> j <br /> Mw_2 /;t-q 9�. q X <br /> mw-4/2--1 -qLj <br /> e inqurs a y: (Signature) <br /> ece a r n re r <br /> 514kdaV¢ 7'. •� - Date/Time <br /> Relinq y: ( R ived y: ( ign e) A l!cr f. j 4t c W cf•I Q A C Date/Time <br /> ell s : ( rgna ure Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> ------------ <br /> Dispatched by: (Signature) Date/Time Received for Labor <br /> Da (rime <br /> Method of Shipment: <br /> Laboratory Name <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />