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_ CHAIN OF CUSTODY RECORD <br /> Geological <br /> Audit Services , Inc . Date 6iy" g3 Page of z <br /> EV— En Vl�-017177e171a/PIofessiona/s <br /> 1803 West March Lane, Suite A - Stockton, California - 95207 -(209)956-0264 <br /> Project Manager <br /> Client FaKk ofSTocAlo� f1�1K'. f�lr. 366% (,lrru7r9 Kolb �,! Tests Required <br /> Phone Number <br /> / <br /> _ Samplers: (Signature) ;'�� Invoice: <br /> do* <br /> Project Name ro 1 GeoAudit <br /> Client <br /> Sample Location Sample Type No. of <br /> Air COntS. <br /> Number Description Date Time Water Solid / Notes <br /> Comp. Grab. /�j� <br /> � Li 0 n X x <br /> es " 5 x I xx <br /> 6 5 <br /> B6 - 5- X X <br /> F6 - l0 X x <br /> Relinquished y: (Signature) ecerve y rnature <br /> gDate/Time <br /> t,-w.nLt,���...�L� Sld�,�fa►� T. N. _ 6���i-�3 l�;ay� <br /> Relinquished by: (Signature) Received by: (Signatu ) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Laboratoryb <br /> y' Date(Time <br /> Method of Shipment: Laboratory Name <br /> SParr�.o t� <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br /> r <br />