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TIP <br /> tib r r M IM = 1! <br /> CHAIN OF CUSTOD ECORD <br /> =� Geolo�C ical Audit Services , Inc. 3ci)o � Page Z"17= <br /> � 1803 West Much Lana. Sults A-Stockton,California•95207-{209)9513.11264 <br /> Cid ! Project Manager <br /> �akC ► Tests Required <br /> 0 hdlg /ll 0 Phbne Number <br /> Samplers (Signature) invoice- <br /> Project Name f GeoAudd C] <br /> �. -� / /f Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Cate Time Water Air Sold <br /> Collis- - / Nates <br /> Comp Grab <br /> 5 ` ItiS <br /> 9 nqur e y (Sig"G) ecew gnature ate►Time <br /> 1d; ev <br /> Relinquished by (Signature) Received by (Signa re) Ute/Time <br /> ehnquishad by (Signature) Received by Mobile laboratory tot field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Recerved for laboratory by DateMme <br /> Method of Shipment Laboratory Name <br /> Special Instructions I hereby authorize the perlcimance of the above sndicated work <br />