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41 Geological Audit Services, Inc. CHAIN OF CUSTODY RECORD r <br /> Date 3 Page , of�� t <br /> �r <br /> Client PROJECT MANAGER <br /> PH NE NUMBER — —�— <br /> PROJECT NA-mE SAMPLERS Sic_galur <br /> 13A644 PI-597 711Z <br /> SAMP = `„Pc <br /> TIME <br /> SAMPLE LOCATION I DATE t• y-cp� AiR SOL NO OF TESTS <br /> NUMBER DESCRIPTION tl Cp G,ab CN7NRS REQUIRED <br /> 7?917 <br /> i <br /> f ! <br /> t <br /> Rehnignature Received by: ( lgnatwe) DaletTime <br /> 314(ild /S <br /> AehnQwSned Cy:(Signature) Received by:(Signature) ! 'S <br /> Date/Time <br /> Relmqursned by (Signature) Received by Mob11e LaDoralory for eia ana yS-S OatelT�me <br /> (Signature) <br /> DFSpatched by:(Signature) Oate/Tlme ReceweG for LaGoralory by: Date/Time <br /> MethOC of Shipment: I <br /> I hereby autnonze the performance of the above indicated work. <br /> Special tnStruclion3: <br /> SOURCE Aaaotee From U.S EPA. 19aS <br /> 6c16100 <br />