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CHAIN OF CUSTODY RECORD <br /> Geological ical Audit Services , Inc . Date -�/�--page �ot <br /> — -=�_'"- EnY�ronmenta/Professnonais <br /> '1803 West March Lane,Suite A Stockton, California-95207 (209)95"264 <br /> r <br /> Project Manager Tests Required <br /> Client & <br /> Phone Number <br /> Dtfi71� [�(zA-OTZ 7 � 57s-47-0 <br /> I CA q-(1-7v I Samplers (Signature) 1 Invoice <br /> �( GeoAudlt <br /> Project Name Dc.71-2.4F,07W6T Client <br /> Sample Type Noof <br /> Sample Location Solld o is Notes <br /> Date Time Water <br /> Number Description Comp Grab Air Coats <br /> einquis a ignature) vel— <br /> ecelve y (Signature) <br /> Dale[Time <br /> DatelTime <br /> Relinquished by (Signature) Received by (Signature) <br /> Date/Time <br /> Reli ure Received by Mobile Laboratory for field analysis (Signature) <br /> i <br /> Date 11 <br /> Received for La ryQ <br /> JAe <br /> Dispatched by (Signature) C5 1�� <br /> � e ! :7r 172 <br /> ab ory Name <br /> Method of Shipment <br /> I hereby authorize the performance of the above indicated work <br /> Special Instructions <br />