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� w� � �Ir � e» � � gt■11� t�� � <br /> CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc. Date 3Page --�—of� <br /> �� EnY�ronmenta Prnfe.�s�ynarCs <br /> it 1803 West March Lane Suite A Stockton California 95207 (209)956 0264 <br /> Client Prole Manager <br /> r Tests Required <br /> Phone Number <br /> 20 q -S SU- 0" <br /> Sam lers (Signature) Invoice <br /> J <br /> Pro ect Name GeoAuddj <br /> Client ❑ <br /> Sample Location Sample Type Solid No of <br /> Number Description Date Time Water Air Conts Notes <br /> Comp Grab <br /> Q7- 35 aosr„-- -7 35f � �3 �1 �� X — <br /> �3� - 1+0 y0 ; q0 <br /> 45 ' 55 <br /> e in uish y nature) starvey ignature <br /> !F>7 }� TArr Date/Time <br /> Reli quashed by (Signature Received by Signature) �LIE� —C�?JG5%6� &JS ��j4� Date/Time <br /> R r bur a (Signature) RRe �lMet—Wyr d ana srs nature! , (Syg DaterTrme <br /> Dispatched by (Signature) -1P w7aternme Received for Laboratory by Date[Trme <br /> Method of Shipment Laboratory Name <br /> WCs, <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />