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CHAIN OF CUSTODRECORD <br /> Geolooical Audit Services , Inc . Date =k3 Page _ of� <br /> _ =`� Eni�ironmenta Piafessiona/s <br /> ROLAW 1803 West March Lane Suite A Stockton California 95207-(209)956 0254 <br /> Client rZ . . Proj ct Manager <br /> I Tests Required <br /> Phone Number <br /> ` Samplers (Signature) Invoice <br /> 1� <br /> Project Name L,7, I`� _ V r c << -,� v� p GeoAudit 4 <br /> Client ❑ <br /> Sample Location Date Time Sample Type Solid No of <br /> Number Description Camp Water Air Conts �e Notes <br /> Grab <br /> D5 <br /> 5 -S <br /> euVi y { ignature �cerve y jgnature Date/Time <br /> i <br /> ('C^ Int.c <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> r <br /> Dispatched by (Signature) Date(Time Rec ed far Laboratory by DatelTime <br /> IZ2 eo iz& 1 <br /> Method of Shipment fif Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br /> n0 i ICJ 1 <br />