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Geological Audit Services , Inc, CHAIN OF CUSTODY RECORD <br /> EnruMmwtg7R"e$S"7als Date I ' �R S <br /> ltttlR� Page �_ of <br /> - I603 Wast Match Lana, Suite A Stockton, California 95207 (209)958 0264 <br /> cis S <br /> Client R L( 5 J t L�R + Project Manager <br /> Tests Required <br /> I�ob ma rl <br /> Phone Number <br /> ( oq) g S 6-0.3-6 <br /> Samplers (Signature) Invoice <br /> Project Name 4 P; V1 Re p�1, � ^ GeoAudit <br /> Client p <br /> Sample Location Sample Type a <br /> Date Time No of <br /> Number Description Comp0,.i;— Air Stated Conts Nates <br /> -��-q ly-o3 X Z X 43554 <br /> Mw-3/1 - );—qy 43555 <br /> /150- j /1- I) -q5— 3L� 43555 <br /> S 0 j)-pry 4350 <br /> A 5 0 -3/ 1 - ))-qq' 43555 <br /> e Inquts e y ranelwe c i re <br /> yr Y I <br /> � Date/Time1 1-17.9g116 <br /> -4 <br /> Relinquished by (Signature) Received by (Signature) <br /> Dale/Time <br /> Relinquished by (Signatu(e) Received by Mobile Laboratory for field analysis (Signature) <br /> PetelTlme <br /> Dispatched by (Signature) DatelTime Raceived for Laboralory by <br /> Dale(Time <br /> Method of Shipment _ Laboratory Name <br /> )a r f <br /> Special InstructionsMFR 1 hereby authorize the performance of the above Indicated work <br /> AU <br /> APPM <br /> HEAD SPACE"BSENr�L. CaNrAIrI�S_ <br />