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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc. Date I - 16 -"q . Page o1 <br /> �= Ern�rrtx�menta Prn/essa�s <br /> toad►Now 1603 West March Lana,Suite A- Stockton, California 1)5207-(209)9560264 <br /> SS�26 <br /> ClientProject Manager <br /> R u sSe C�n i <br /> Vo b M a rly Tests Required <br /> Phone Number <br /> (;Z 0q ) `156 0 - 0-I <br /> Samplers (Signature) `Invoice <br /> 1 ~- �' <br /> Protect Name L �d�' 1� �ro 5 7kzt, GeoAudith` Client ❑ <br /> 0 <br /> pe <br /> Sample Location Sample Ty <br /> Date Time Water Solid No of Q� Notes <br /> Number Description Comp (arab Air Cants � <br /> A50 - I /1- 1 -qy -1 -4y 10.4$ X z X e3594 <br /> I <br /> A5D-A/t — 15 -q5" 10'57 43595 <br /> rt I <br /> }iso-3/1 - 15--q57 43596 <br /> r r <br /> Bel <br /> f <br /> rn urs a y (Signature) a i s y ignstur Date/711 <br /> e <br /> tr—� l� S a s <br /> R11inquishad by ( rgnature) Received by (Si(nalure) Dat !Time <br /> ehnquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date(Time <br /> Method of Shipment Laboratory Mame <br /> Special Instructions UMILL1101. VVVJZ 1 hereby authorize the perlormance of the above indicated work <br /> KEIT`_!1 PRESERVASN <br /> HEAD RPACE AR i✓ .► <br />