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Geological Audit Services, Inc. CHAIN of CUSTODY RECORD <br /> ,r <br /> Date S ?age 2 <br /> of <br /> 1✓ <br /> S <br /> Client PROJECT MANAGER <br /> ICS <br /> ?5n3 m moi_ <br /> PHONE NUMBER <br /> �� ' ) 9S CQ-DZCo <br /> PROJECT NAME SAM?LER (Sig.7%j <br /> :� <br /> rIl <br /> SAr�iaL ;vaE <br /> SAMPLE LOCATION DATE TIME ;rA =R E A[R SOLID NO. OF TESTS <br /> l4Ut�SER JESCR[PTION Como Grab. f GNTNRS \ REQUIRED <br /> .1- R(t <br /> •r -- - _ - - -- - - -- - - - - -- - - - -- -- - - - - <br /> 1 F <br /> � r <br /> Rehnpu�d ( lure) Received by:(Signature DalelTime <br /> r rTF- <br /> :�✓ , IGC¢_c4.� '- 6�/i�G [qL/ / ?z I f C <br /> 4 Qurshed by:(Signature) Received by:(S�gnature) �jC��J �'ZJ �7�-r�} :�-' 7J DL Date/Time <br /> 1 <br /> RehnOuished by:(Signature) Received by Mobile Laboratory for I e c analysis OatelTime <br /> (Signature) <br /> I <br /> Dispatched by:(Signature) DatelTrme Rece�Ved for Laboratory by: <br /> Date/Time <br /> I i <br /> Method of 5niprnent: r I hereby authorize me performance of the above indicated woo rk. <br /> Special Instructions: <br /> I <br /> rS�t7RCE: Acapte0 from U.S.EPA. 19as <br /> ccW 100 <br />