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Geological Audit Services, Inc. CHIN o CUSTODY RECORD <br /> Date image 3 of <br /> "V= <br /> ttt V <br /> r <br /> Client PROJE T MANAGER <br /> PHONE NUMBER <br /> PROJECT NAME SAMPLER .. icna ur <br /> SAMPLE TvPE <br /> SAMPLE LOCATION DATE TIME WA ER AIR SOLID NO.OF TESTS <br /> NUMBER DESCRIPTION CompGrab. CNTNRS REOUIRED <br /> - <br /> 17 <br /> /7 >( ! <br /> W- <br /> W-20 <br /> Relinherr:- lura ec wed b (S gnalure) Date/Time <br /> Relinquished by:(Signature) Received by:(Signature) 1 Date/Time <br /> Relinquished by:(Signature) Received by Mobile Laboratory for field analysis 140ale,[rTime <br /> (Signatufel <br /> Dispatched by:(Signature} <br /> Date/Time Received for Laboratory by; Date)TimE <br /> Method of Shipment: I <br /> I hereby authorize the performance of the above indicated work. <br /> Special Instructions: <br /> SOURCE:Adapted Ir 3 <br /> .EPA,49aS ^C#•tp� <br />