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i �_ i i i i i 1• � �_ _i << � i i ii <br /> CHAIN OF CUSTOD .r�iiECORD <br /> Geological Audit Services , Inc. Date 11 10-a3 Page <br /> _= - EnYironmenta Professionals <br /> O 1803 West March Lane, Suite A-Stockton California-95207 (209)956-0264 <br /> Clientf Project Manager <br /> M q h u� � 5uh Cti e -t< got norN Tests Required <br /> Phone Num r % <br /> (P-C'-C 415 -c2-6-� 't <br /> Samplers (Signature) \� / iInvoice <br /> r� <br /> Protect Pa<, GeoAudit E] <br /> Name f i� t?a 5 Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Comp Water <br /> Air Solid Conts `�� �: /� Notes <br /> Mw- 3 11-10.13 13: 357 X 3 <br /> Kw-2Ji1-10- 13 <br /> M,w-3/11-10- 13 <br /> I <br /> Re i s b g azure Rec anature Date/Time <br /> 3JaKdetrd TA.T. <br /> Reis uis n at a Rec iv (Signal et Date/Time <br /> 1 rJc.L_►sc� � cc,a f Q� Illi � <br /> Relinquished by (Signature) Rece y bile Caborat r for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date(Time <br /> Method of Shipment Lab o atom me <br /> �T <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />