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I <br /> CHAIN OF CUSTODY RECORD <br /> -� Geological Audit Services , Inc . Date � �-L Page ( aft <br /> ... E�t/�mnmenta Professionals <br /> ��..� <br /> `" 10O3 Went March Lane Suite A Stockton California 95207 (209)956 0264 <br /> Project Manager <br /> Client � I � r•�S Tests Required <br /> Phone Number <br /> R"I f(7L _&2C t� <br /> Samplers Signature) Invoice <br /> Project Name C f�u f �L a �J Z4 1., GeoAuda <br /> 66 '�l Client ❑ <br /> Sample Location Sample Type <br /> Date TimeSolid No of <br /> Number Description Water Air Cents Nates <br /> Comp Grab <br /> 11 � <br /> f�b <br /> er s nature ac o rgnatu a Date/Time <br /> Whnqu1sho!Zj1gnaueT______ <br /> sh d (SI ecelved b Si nature (1 Date/Time <br /> 7777 <br /> (Signature) + DatelTime <br /> Dispatched by (Signature) ow Laboral ry y Dafe/Time fC� <br /> i bl�u_qs <br /> Method of Shipment Labrgratory N me <br /> Special Instructions I hereb lhonze ! e performance o! a above Indicated work <br /> � I <br /> i <br /> i 4 <br /> VI_ <br /> } <br />