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G CHAIN OF CUSTODY RECORD <br /> SE <br /> Geological Audit Services , Inc . <br /> ;.V EnV%/onmen1a PIolessiona/_s Date Page -- of <br /> _r 1909 West March Lane, Suite nStockton, Calilomia 9520/ (209)956(l'1l;-0 <br /> Client Project Manager <br /> ana <br /> --- � � •+� s f���Lc�J���n�-s-��_�e�Sill_ . g <br /> Tests Required <br /> -- - Phone Number 1 j <br /> — --- - - -- S,a(nplers: (Signature) q <br /> Prr,,ect Name 1' mkt(.(v`,A t_.�-<_() Invoice: <br /> _ ��' GeoAudit>< <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Date Time - -- - No. of j / <br /> Description _.—Water _ .solid <br /> Comp I Grab —Air Conts. '/ I Notes <br /> ZV`sq Mot1t wNic) Well l <br /> �tluiq is a 0 ignaturo --- <br /> Rocelvlq lir. <br /> fir--�-------------``-++ — //11 <br /> Rohn hd ^ //' J1t't nc�a UGI r� TDate/Time <br /> - - Iiecefrve b .,' th — ----- J <br /> Date/Time <br /> igna 0. <br /> Receive d by Mobilo Laboratory for field analysis: (Signature) t! tl ! ! <br /> � ---- ay;, �►r L• .,:. .:;'�✓ Date/Time <br /> Dispatched by. (Signature) _ t' <br /> Date/Time Received for Laborat <br /> �— -------- _ _ Date/Time <br /> Method of Shipment: 1� ?A�( 17yt(' <br /> Laboratory Name l l (I lJ > <br /> Speael Instructions: ------- <br /> { I hereby authorize the performance of the above indicated work. <br /> - <br /> t <br />