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-= G e CHAIN OF CUSTODY RECORD <br /> ological Audit Services , Inc . Date 11 -I -� �- Pa <br /> ge —_ of <br /> �:� Envo►a�ml�nls P�ea/essAnna/s --__-.--__- •-- -._ . . <br /> 1603 West Match Lane. Suite A Stockton, Cnlilouria JWU/ •(709)956-0:P64 ' <br /> chant J0.t'YI� C Project Manager <br /> -L — _ Stil ly VV I ke r Tests Required <br /> Phone Number <br /> q• rl 5C�-0204 <br /> Samplers: (Signature) Invoice: <br /> Pr ' Name / GeoAudit <br /> Race, ����i a� 't <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date lime No. of <br /> Number Description Water Air Solid Conte. Notes <br /> Comp. Grab. <br /> NtW-t �t,•�-q•� I I Iz�t Iq� X 3 <br /> in\A <br /> e t y: rOMlut ucuwu ,y: �,ignruuru — — <br /> ay1 zc IrG• rt ale/T'me <br /> shad by: rgnalua) Rocoivo y: (Signature) Y1GCG� (Z"�—� '�: Z� <br /> Dat /Time <br /> elinaursh d by:(•19natut lot for liold anal sis: (Signature) <br /> Dale/Time <br /> Dispatched by:(Siynatwe Dalu/Time Ilecoived loon <br /> �1 ' ato/Time �] <br /> Method of Shipment: 1. 1�(5#A2- <br /> aboratory Name <br /> Special instructions: 6Q7r <br /> 1 hereby authorize the perlormance of the above indicated work. <br />