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t� i�r wllwl its �■� t� tititititit■ womb tititititt! � F <br /> CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc. <br /> -- Ernnror7menta P%fessAvna,(s pate 3"Q Page of <br /> ��•� S <br /> !; 1603 West March Lane, Suite A-Stockton California-95207 (209)956-0264 i <br /> Client y Project Manager <br /> V1 C Cit e(rYr vt Tests Required <br /> Phbne Number <br /> coq a96-ti),61 <br /> Samplers (Signature) Invoice <br /> Project Name /GeoAudnf va <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Solid `/�� , Notes <br /> Comp Grab Air ContS <br /> Mw- i f -� 43 11"a'� 3 z•oti�� X 3 X <br /> � Mw'�.jj1-7-73 ) 3 X <br /> ` 1`1 3lf}-3 73 z= 3 5P w X X <br /> Relinquished by (Signature) Rel rve y i ly(� P Date/Time <br /> Relinquished by ( ignature) ry S at Date/Time <br /> Aed d ( re Received by Mobile Laboratory for field analysis (Srgnat re) Date/Time <br /> chi y u Date lTrme Received for a rat �j !Time <br /> --� 1 G , 3r <br /> Method of Shipment Laboratory Name <br /> vVf-: 5j <br /> Special Instructions I hereby authorize the r". a r dicated work <br /> dat VY <br />