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i <br /> CHAIN OF CUSTODY RECORD <br /> -� <br /> Geological Audit Services , Inc . DateIozob-1Page of <br /> _� En�ironmen/a Pin/essiona/s <br /> 1609 West March Lane, Suite A - Stockton, Calilornia - 95207 - (209)956-0264 <br /> Client, Project Mager <br /> Tests Required <br /> Phone Number <br /> Sapplers: (Signature) i� Invoice: <br /> Pr it'�' <br /> S P�a C GeoAud <br /> �� Client ❑ <br /> Sample Location Sample Type <br /> Number No. of <br /> Description Date Time Water Solid n Notes <br /> Comp, Grab. <br /> Air Conts. /\\ <br /> Mon&M'4o, Lok I) I I012�164 ,o. oo X �( <br /> e rnq is a rgnature ucuw ,y �I re / <br /> /► r Date/Time <br /> Nmt G <br /> ac <br /> ive b t <br /> Date/Time <br /> rflO° ) Received by Mobile Laboratory for field analysis: (Signature) � <br /> 1� <br /> Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laborat r b <br /> - <br /> Date/Time <br /> Method of Shipment: O 7"l 1 -7,t,t,S <br /> Laboratory Name <br /> t-rE <br /> SpacialInstructions: `_ <br /> �r ..- <br /> ; ,� 4� I hereby authorize the performance of the above Indicated work. <br /> IN <br />