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CHAIN OF CUSTOAECORD <br /> _ Geological Audit Services , Inc. <br /> Er7Yironmenla/Professlongls Date `1 q y Page --!i— o; <br /> _ 1803 West Match Lane Suite A Stockton California-9145207 (209)956 0264 <br /> r <br /> Client P. 11 51 e w d r T- Project Manager AM 05 116 <br /> Fd 0 M C(K I Tests Required <br /> Phone Number <br /> (xoq) "156 -0)4 <br /> Samplers (Signature) Invoice <br /> P roject Name 5 r�W a i^�t5 to C Qmak`' GeoAudlt 50 <br /> Q� h Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid No Con of � Notes <br /> Comp Grab <br /> 5P'. - 19 Slot t ilt I �, Fa;f -13-`f5 10110 <br /> 5P ,2 -,ZU tM , FUST AK0 t0' I <br /> i 1 <br /> t <br /> 50279 <br /> { t <br /> f <br /> Relinquished y (Signaime) ece ve y ignafure <br /> S �����Q. illi' Date/Time <br /> 7 t�q 1 1� 3 ;_ <br /> Relin�rshed y (519nature} <br /> J� ace ed by gnalure} Date/Time <br /> Relinquished by (signgnalure} ~ <br /> Rece ed by Mobile Laboratory for field analysis (signature) Date/Time <br /> Dtspalched by (Signature) Date/Time {iecetved for Laboratory by <br /> Date/Time <br /> Method of shipment <br /> Laboratory Name <br /> ti ir�f'�ilrn M`-Catl kfit <br /> Special Instructions <br /> i�C�K � PPBMVA roWn" �_ Jt ��y . I hereby authorize the performance of the above indicated work <br /> G4C(1i' C ,R t i, )ASv , `y'vLcA 't—' <br /> HEAD qp r ENE G�WAI^)��5 _.... <br />