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i <br /> Geological Audit Services, Inc CHAS of cusT RECORD. <br /> J <br /> — r <br /> Date Q ! Page oI�T. <br /> tl� <br /> � PROJECT MANAGER <br /> Client r rt/�7(L� i�2�/�,r Z�N 06 L5 IPM-A <br /> PHONE NUMBER <br /> PROJECT NAME SAMPLERS (S+Cnal <br /> SA14:> z <br /> SAMPLE LOCATION DATE TIME tvA--p I AIA SOLID *40 OF TESTS <br /> NUNgER 'DESCRIPTION Como Grao CNTNRS REOUIRED <br /> I ! 1 1f n <br /> 7W-o( ' g <br /> / n <br /> I I , <br /> 1 <br /> Relrrrou b� (S rel Received by (Signature) DatelTrme <br /> r, ts "I q <br /> Relrnpurshed by (Signature) Received Dy (Signature) ' DatelTrme <br /> G^ 3 P Dale/Time <br /> Re(rnQuished by (Signature( Received oy Mobile Laboralon for +,elo ana+ys-s 4 ^ <br /> fSignalure) !! <br /> Dispatched by(Signature) Date/Time ReCeivee for Laooratory Dy Date/Time <br /> Method of Shipment I'wieby authorize I-ie performance of the above indicated work <br /> Special Instructions <br /> SOURCE Aoapred from U S EPA 1985 bGp'00 <br />