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Geological Audit Services, Inc, CHIN d 'CUSTODY RECORD <br /> �.'— �� Date L Page of <br /> V�`" <br /> f• <br /> Client PROJF MANAGER <br /> PH NE NUMBER <br /> PROJECT NAME <br /> SAMPL3R ;SiC torp} <br /> SAMPLE TvPE <br /> SAMPLE LOCATION DATE TIME WATER _ AIR SOLID NO.OF TESTS <br /> NUMBER DESCRIPTION <br /> Comp. I Grab. CNTNRS REQUIRED <br /> 1n.r-37 <br /> I s <br /> Refingw ed P(Signature) <br /> ura) ;;Rtec e bb: Sig aturef <br /> ate►Time <br /> Reiinqui5hed " AK Received by:(Signature) 41n <br /> telTime <br /> Relinquished by:(Signature) Received by Mobile Laboratory for herd andiy5i5. <br /> teime <br /> (Signature) <br /> Dispatched by:(Signature) Date/Time Received for Laboratory by: <br /> Date/Time <br /> Method of Shipment: I i <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: <br /> SOURCE-Aaapied Irom U.S.EPA 1"s <br />