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CHAIN OF CUSTODY RECORD , <br /> �-li Geological Audit Services , Inc . <br /> Date A--13Page• � � 3 <br /> 11 <br /> En�imen/a/ProfessA�a�s� <br /> 1803 West March Lane, Suite A• Stockton, California• 95207 •(209)9560264 <br /> 411— <br /> Client <br /> rClient �p� � SGg ProjepipAan-ager , iTerms Required <br /> Phone Number , <br /> 7(0 3� <br /> Samplers: (Signature) Invoice: <br /> Project Name Vj ---�GS "1GeoAudit x <br /> (� �7 Client ❑ <br /> Sample Location Sample Type <br /> Date Time No.of <br /> Number Description Water Solid Notes <br /> � C <br /> Comp Grab Air Conts. <br /> 5 i <br /> �J s- -ef, <br /> r <br /> 31820 <br /> Re n s y nature •ce�w+•® y: (sign ur• �- Date/Time <br /> inqdrrAed by: (Signature) Received b7 (Signature) DatelTim• <br /> Relinquished by' (Signature) Received D Mobile Laborato for field analysis (Signature)y rY Y ( 9 ) Oate/Time <br /> Dispatched by: (Signature) Date/Time IReceived for Laboratory by: Date/Time <br /> Method of Shipment: Lab r tory • <br /> VX-LJ <br /> Tffl <br /> boll Pr <br /> Special Instry��}� �� O <br /> �7VW COMMON ' '1"- Op�l� I here autho 'ze the perform Ge of the above indicated work. <br /> �..� ��fl I RUt <br />