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I_ l� M M M lEbm M � <br /> CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date � -h _q3 Page ---L of 7 <br /> Environmenla Professionals <br /> �•� <br /> 1803 West March Lana Suite A Stockton California 95207 (209)956 0264 <br /> L� <br /> r <br /> ClientProject Manager <br /> �[ ^� Mq v',�V Tests Required <br /> Phone Number / <br /> S \ / <br /> amplers (Signature) �� invoice <br /> a / <br /> Project Name Ga 1/� 1„ i/ �, GeoAudrt <br /> lr J / Client ❑ <br /> Sample Location Date Time Solid Sample Type No of <br /> Number Description Cor Water <br /> Air Cants �� r� Notes <br /> Y y <br /> Relinquished y (signature) ecetv'ed y (T.gnature F ,y Date/Time <br /> Relinquished by (Signature) Received by (Signature) <br /> Date/Time <br /> Rehnquished by (Signature) erved !e�abaralar or Icsld�na �L <br /> oatelTime <br /> Dispatched by (Signature) DalefTrme Received for Laboratory by <br /> — - - - DatefTime <br /> Method of Shipment Laboratory Alamo <br /> Wei 7 <br /> Special instructions I hereby authorize the performance of the above indicated work <br /> 4 <br /> t <br />