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CHAIN OF CUSTODY RECORD <br /> =� Geological Audit Services , Inc . Date � � �� -g Page _._•_— of <br /> Environments Professionals <br /> 1803 West March Lane, Suite A• Stockton, Celilornin - 95207 - (209)956-0264 <br /> NEW <br /> r <br /> ClientProject Manager <br /> NeW)0. Bob,} MQi^� Tests Required <br /> Phone Number <br /> (,7011 ) �1 6- 0,2 61-1 <br /> Samplers: (Signature) Invoice: <br /> Proiect Name A r'fi A�T 15T5 ,�� nl�'dl c xt%zl� `�\ GeoAudft <br /> Client <br /> Sample Sample Type <br /> DTime Location Solid No. of ' <br /> Number Description ate me Water Air Conts. ell Notes <br /> Comp- Grab. <br /> M -5/1 - <br /> KW-6/1 - -26--u <br /> W/V-711 - 6-q <br /> /Relinquished y: ignatura ecai y: rgn e 5'�dNC Q J r �� Date/Ti <br /> )'l1''I l;l 'SLC 7 .s► Al <br /> Retinquishe (Signa[ Rifcoivo Sign lure) �� � Ax4e pE. eP'414C_ oat fTi e ' <br /> Relin fished by: (Signature) Receive y ile Labor ory for Bald analysis: (Signature) Date/Time <br /> f <br /> Dispalched by: (Signature) Dato/TirnoRocaived for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> A ; Ii <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />