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Geological Audit Services , Inc. CHAIN OF CUSTODY RECORD <br /> Date 6 - 3 -a� Page �_of� <br /> Environmen1a/Prolessiona/s <br /> 1803 West March Lane, Suite A-Stockton, California-95207-(209)956-0264 <br /> Now <br /> A <br /> Client Fq I c o"1 F int rProject Manager <br /> Alin 1B Kav;h NcK)b1fov1 Tests Required <br /> P� 0. 6 o A 12- 5- 7 Phone Number <br /> (2.oq) 45 6-v,�6y <br /> 57a c � t ii Tf91n G q s;Z 0 Samplers: (Signature) Invoice: <br /> etl /eoAuditProject Name M DovtaId X5 la h � ,'��'"``` � ; Client <br /> Sample Location Sample Type No. of i <br /> Date Time Water _ Solid K �.-' Notes <br /> Number Description - - Air Conts. <br /> Comp. Grab. <br /> IV- ( 5E 4 1, C;/ 6-�,qy 13:K 7 --- -- x �ow1potj� e T 1 -- <br /> 5 y1 <br /> N ' _t4 <br /> N13 •��- ---- -- -�— I -- _ ::�#aha>�-1� <br /> ur <br /> { r <br /> -Ileiinqurs a by:—( rgnature) ecerve y: ( rgnature) — <br /> Date/Tin <br /> ` 51clodAvd, T-A -T- 6-6-9y /I`._0_ <br /> Relinquished by: (Signature) Re y: (Signature) - Date/Ti e <br /> In-�-S�y 1cHA <br /> Relinquished by: (Signature) rued by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> Method of Shipment: Laboratory Name <br /> s e <br /> Special Ins uctions: ^ - ---- I hereby authorize the performance of the above indicated work. <br /> HEAD SPACE AM <br /> jC CI N AI -- -- <br />