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M MWM 1=1 M M M M M M = = Mdr <br /> Geolo IcaI Audit Services , Inc <br /> Nk. b CHAIN OF CUSTODY RECORD <br /> - EAY�ronmen�a Professiona/s <br /> Date Y'j c.1 Page �_ of l <br /> - 1863 West March Lane Suite A Stockton California 95207 (209)956 02G4 <br /> Client MCfou� + sq�tc � 2: Project Manager Tests Required <br /> Phone Num er <br /> (?-oq ) q�b -0.1 - <br /> nature <br /> Samplers SI <br /> p (Signature)) invoice <br /> P r oltact N ame �d i ►c a 5 )4WD W4.,���\ GeoAud It <br /> Client ❑ <br /> Sample Location Sample Type ah <br /> Date Time water Sofia No of <br /> Number Description Notes <br /> Cornu Grab Air Cants � <br /> M W- 1/q-i —u 16 "34 X 3 <br /> M w"a/q 16-q LI <br /> 6,^u 16 <br /> Relinquished y igmkture acai ic�naturo <br /> `�'k? 51a+� c-lQ�'� �-�•�' � to/Time I <br /> Relrnq 5 ignat Racarved by i atu e) <br /> tefrrme <br /> Rel[ngws ed by (S[gnalure) Rec <br /> "ad <br /> o Laborat y for!laid anaiys,s (Signature) Date/Time <br /> I <br />` Dispatched by (Signature) DatolTimo Recomed for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> A? h <br /> Spacial Inalructlons I hereby hor[z Jth arformance of th above mdreated work <br /> t <br />