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-�� G CHAIN OF CUSTODY RECORD <br /> ._._ Geological Audit Services , Inc . Date K)17-1 144 Page of � <br /> w � <br /> Environmen�a Pnn/essiona/s <br /> 1Lane, --- - -- -- - <br /> _� 00 Wast March S <br /> Suite A• Stocklun. Culilurniu -J5'LU7 (709)J!A;W4A <br /> r <br /> Client Project Manager <br /> '�IJr <br /> Cl 13c)19 h/ct Y `/ Tests Required <br /> q;3:56 )V 1f - Phone Number - --- - <br /> (2tx�) <br /> Samplers: (Signature) Invoice: <br /> Project Name '•e� I")a coo GeoAudit;R' <br /> Client ❑ <br /> Sample Location Sam le Type <br /> Number Description Date Time Water Solid No. of Notes <br /> Comp. coal). Air Conts, <br />-M-W 1-- 10 M W f - -der,�"k d4pkVt_ 10-2J--(14 g: <br /> M W t - 15 MW 1 - is C1c4r- de pVk 10-2141 q,o, - - ------ — ——— <br /> rnQwa • y: rpnatura ecurvui Lv:7^,rynaturu ---`�----- <br /> L <br /> • � it p �..,,.t„� TA"I' Date/Time 1 <br /> elrnQwsMd y: Signature) �f u�' L --- 1�'}�-9 y )JG^• V <br /> R <br /> eceived by: (Si0nature) Dale/Time <br /> nebnQursMd by- (Stgnalura) Received by Mobilo Laboratory for field analysis: (Signaluro) <br /> Date/Time <br /> DapelcMd by: (Signature) Data/limo Ti`e—co'vVl for Lboratur y <br /> Dateme <br /> Method YU <br /> ethod of Shipment: ��r <br /> Laboratory Name <br /> Special Instructions: ---O F--,S <br /> - <br /> ,S t <br /> I hereby authorize the performance of the above indicated work. <br /> I�xal.4x-{lal <br />