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i <br /> CHAIN OF CUSTODY RECORD <br /> Gem logroC aInc .Audlt Services , DateL�?'�� _ Page ( of f/ ,'• <br /> �.sr,� a/ <br /> ® 1803 Wats!March Lane, Suite A-Stockton,California-95207 (209)95"264 <br /> r <br />' Client T41 � Pro'ect Manager <br /> B Tests Required <br /> Phone Number <br /> Samplers: (Signature) `� / Invoice: <br /> Protect NameCrIl1�R- C�p-A� �nI 77� �` >� ii�/ //eoAudit <br /> / i Client <br /> I Sample Type <br /> 4/1' <br /> /` / <br /> Sample Location Date Time Water Solid No. of f�� / '/ Notes <br /> Number Description Comp. Grafi, Air Conts. : ' <br /> r <br /> 332''4 <br /> 5. <br /> f7� <br /> fy „ J.<: <br /> f - <br /> I� <br /> PRM <br /> .. <br /> SPACE ABSENT�iI APPRUPALTE r/ <br /> in uis tt TAIN <br /> .g u y: tgnature <br /> fDatafTime <br /> I inquishe by: (Signaturof Received by: (Signature) <br /> Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for lield analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: <br /> Date/Time <br /> Method of Shh'ipMont: Lbo Name <br /> ESpecial Instructions: I her thor s I e performance 1 the above indicated work. <br /> C-01"AQ- Y" <br />